compliance training

ABA therapy is not like typical parenting

Content note: This post is about the difference between intense behavior therapy and more typical forms of rewards and punishments used with typically developing children. It contains graphic examples of behavior programs, and is highly likely to be triggering to ABA survivors.

Anonymous said to realsocialskills:

I just read your thing about people with disabilities and their interests. Don’t people do the same thing to typical children? Restrict access to things enjoyed until act ABC is completed? For example, growing up, I was only allowed to watch tv for 1 hour a day IF I finished all of my homework and schoolwork related things first.

realsocialskills said:

It’s not the same (although it has similar elements and I’m not a huge fan of the extent to which behavior modification techniques are used with typically developing children either.)

Here’s the difference: Most children actually should do their homework, and most children have interests other than television. Typically developing children are allowed to be interested in things, and supported in pursuing interests without them becoming behavior modification tools.

(Another difference: intense behavior modification is used on adults with developmental disabilities in a way that would be considered a human rights violation if done to typically developing adults.)

Using behavior modification tools for one or two things in a child’s life isn’t the same as doing it with everything in someone’s life. Intense behavior therapy is a violation on a level that it’s hard to describe.

Intense behavior therapy of the type I’m talking about typically involves:

  • Being surrounded by people who think that you’re broken, that all of your natural behavior is unacceptable, and that you need to be made to look normal in order to have any hope of a decent future
  • Having completely harmless things you do pathologized and modified (eg: having hand flapping or discussing your interests described as “a barrier to inclusion”)
  • Having those things conflated with things you do that actually *are* a problem. (eg: calling both head banging and hand flapping “sensory seeking behavior” and using the same reinforcers to eliminate both) 
  • Being forced to stop doing things that are very important to you, by people who think that they are pointless and disgusting or “nonfunctional” (eg: using quotes from TV shows to communicate)
  • Being forced to do things that are completely arbitrary, over and over (eg: touching your nose or putting a blue ball in a red box)
  • Being forced to do things that are harmful to you, over and over (eg: maintaining eye contact even though it hurts and interferes with your ability to process information)
  • Having everything you care about being taken away and used to get compliance with your behavior program (eg: not being permitted to keep any of your toys in your room)

(Behavior therapy often also involves legitimate goals. That doesn’t make the methods acceptable, nor does it make the routine inclusion of illegitimate goals irrelevant.)

Here’s an explicit instruction from a behavior expert on how to figure out which reinforcers to use for autistic children:

Don’t assume that you know what a child with ASD likes. It is important to ask a child, observe a child or perform a preference assessment. When asking a child about reinforcers, remember that multiple reinforcement inventories can be found on the Internet.

You can also simply sit down with a child and ask them questions like “What do you like to do after school?” or “What’s your favorite food?"or "What toys do you like to play with?”

When observing a child, set up a controlled environment to include three distinct areas: food, toys, and sensory. Then allow the child somewhat free access to this environment.

Watch and record the area that the child goes to first. Record the specific items from this area that the child chooses. This item should be considered highly reinforcing to the child.

Continue this process until you have identified three to five items. Remember that simply looking at an item does not make it reinforcing, but actually playing with it or eating it would.

Notice how it doesn’t say anything about ethics, or about what it is and isn’t ok to restrict access to. This is about identifying what a child likes most, so that it can be taken away and used to get them to comply with a therapy program. (Here’s an example of a reinforcement inventory. Notice that some examples of possible reinforcers are: numbers, letters, and being read to). 

People who are subjected to this kind of thing learn that it’s not safe to share interests, because they will be used against them. That’s why, if someone has a developmental disability, asking about interests is often an intimate personal question.

This isn’t like being required to do your homework before you’re allowed to watch TV.

It’s more like:

  • Not being allowed to go to the weekly meeting of the science club unless you’ve refrained from complaining about the difficulty of your English homework for the past week

Or, even further:

  • Not being allowed to join after school clubs because you’re required to have daily after school sessions of behavior therapy during that time
  • In those sessions, you’re required to practice making eye contact
  • And also required to practice talking about socially expected topics of conversation for people of your age and gender, so that you will fit in and make friends
  • You’re not allowed to talk about science or anything else you’re actually interested in
  • You earn tokens for complying with the therapy
  • If you earn enough tokens, you can occasionally cash them in for a science book
  • That’s the only way you ever get access to science books

Or even further:

Being a 15 year old interested in writing and:

  • Being in self-contained special ed on the grounds that you’re autistic, your speech is atypical, and you were physically aggressive when you were eleven 
  • Having “readiness for inclusion” as a justification for your behavior plan
  • Having general education English class being used as a reinforcer for your behavior plan
  • Not being allowed to go to English class in the afternoon unless you’ve ~met your behavior targets~ in the morning
  • Not being allowed to write in the afternoon if you haven’t “earned” the “privilege” of going to class
  • eg: if you ask questions too often in the morning, you’re “talking out of turn” and not allowed to go to class or write in the afternoon
  • or if you move too much, you’re “having behaviors that interfere with inclusion”, and not allowed to go to class or write
  • or if you mention writing during your social skills lesson, you’re “perseverating” and not allowed to go to class or write

Or like: being four years old and not being allowed to have your teddy bear at bedtime unless you’ve earned 50 tokens and not lost them, and:

  • The only way to earn tokens is by playing in socially expected ways that are extremely dull to you, like:
  • Making pretend food in the play kitchen and offering it to adults with a smile, even though you have zero interest in doing so
  • You gain tokens for complying with adult instructions to hug them, touch your nose, or say arbitrary words within three seconds; you lose two for refusing or not doing so fast enough
  • You lose tokens for flapping your hands or lining up toys
  • You lose tokens for talking about your teddy bear or asking for it when you haven’t “earned” it
  • You lose tokens for looking upset or bored

Or, things like being two, and loving books, and:

  • Only having access to books during therapy sessions; never being allowed unscripted access to books
  • Adults read to you only when you’re complying with therapy instructions
  • They only read when you’ve pointed to a picture of a book to request it
  • You’re required to sit in a specific position during reading sessions. If you move out of it; the adult stops reading
  • If you rock back and forth; they stop reading
  • If you stop looking at the page; they stop reading
  • If you look at your hand; they stop reading
  • Adults interrupt the story to tell you to do arbitrary things like touch a picture or repeat a particular word. If you don’t; they close the book and stop reading.

Here are a few posts that show examples of the kind of thing I’m talking about:

tl;dr Intense behavior therapy has some things in common with methods that are used with typically developing kids, but it’s not actually the same. Intense behavior therapy involves violation and a degree of control that is not considered legitimate with typically developing children.

a shorter version of the last post

As disabled people, we learn early that it’s our job to protect abled people from ever having to notice either the logistical problems or the hate we face. And especially, we learn not to show that it hurts us. And double especially, we learn that we are not allowed to tell friends or caregivers or ~nice ladies~ or others that they are hurting us. And triple especially, we learn that we are not allowed to be angry because that’s ~just the way it is~ and ~people don’t understand~.

I think that protecting abled people from having to notice disability and ways we are harmed as disabled people goes so deep we do it automatically and without noticing most of the time. And abled people *really* don’t notice, because they think it’s normal and natural and have not had any need to challenge it. They feel completely entitled not to have to deal with disability, and the entitlement feels so natural that they don’t even *notice*. And we don’t notice how much we protect them, either.

I’m not sure what to do about that. I would like to start unlearning it, but I’m not sure how. Have any of y'all found ways?

An anti-skill that interferes with friendship

This post is a further response to an ask by someone who identifies as aspie and is struggling to making friends.

Yesterday, I addressed the burden of stigma we face, and how it can make it hard to find people who will treat us well enough to be good friends. Today, I want to start talking about other problems autistic people often have making friends. (Usual standard caveat - if you relate to any of this, it’s fine to use these concepts whether or not you are autistic. Don’t worry about appropriation.)

There are a lot of social problems that autistic people often have beyond other people’s anti-autistic hate. Some of these things are inherently difficult for some of us, and some of them have to do with how we are often taught counterproductive coping strategies.

For instance, a lot of autistic people find it difficult to judge other people’s boundaries and level of interest in interacting (and that’s partly because, as kids, we’re taught that we have to interact with other kids and see them as friends regardless of what we or they want).

Here’s an example of how an autistic impairment and stigma combine to create a relationship problem for some people:

  • One thing that often gets autistic people classified as aspie is having more receptive language problems than expressive language problems
  • People with really good, or good-seeming, expressive language can often cover for the fact that they don’t understand much of what’s going on
  • This allows them, especially as kids, to pass as just socially awkward, or to pass as being too gifted to get along with other kids, or any number of variants on that theme
  • There is often very, very intense pressure on autistic people classified as aspie to cover impairment at all costs and to appear as normal as possible
  • This makes receptive language problems even worse, because it prevents them from getting good feedback on whether they’re understanding anything
  • And sometimes, aspie spaces can make this even worse. Sometimes aspie-oriented communities are centered around helping people to deny that they have language problems, and to say that the rest of the world just communicates wrong
  • (It’s true that the rest of the world needs to work on accommodating people with communication disabilities more - but autistic folks need to acknowledge that they *have* communication disabilities, and a lot of aspie-identified folks like to deny this)
  • Covering up receptive language problems can make friendship really difficult. Friends need to be able to understand each other
  • Which means friends need to be able to admit it and fix it when they *don’t* understand each other

If this sounds like you, it’s likely that getting better at friendship will involve looking more autistic.

More on social problems autistic people often struggle with tomorrow.

Making the point about therapy more sharply

Three year old children in preschool are some of the least socially powerful people in our culture. But, they are routinely given a lot of choices about what they do and how they do it.

They’re not usually required to do painful and boring things over and over with no regard to their feelings or their experiences. And, from time to time, they can say no to something an adult had planned for them and have it stick.

Preschool teachers know that their work depends in large part on getting the willing cooperation of most of their students. That doing things to them over their miserable protests over and over is probably going to end poorly.

All too often, therapy for people with disabilities is less respectful, consensual, and individualized than the average preschool class.

If you’re exercising more control over a ten year old kid with a disability than you’d feel comfortable exercising over a nondisabled three year old child, you’re doing it wrong. All the more so if you’re doing it to an older child or an adult.

Noticing a consent problem

I’m not entirely sure how to describe this, but I know it’s a thing, and I know a *little* about how to deal with it:

Some people have been systemically taught that they are absolutely never allowed to say no to anything. That their boundaries don’t matter, and that they’re not really people.

For this reason, some things you’d normally do in order to establish consent and find out someone’s preferences don’t work *at all*.

For instance, asking “do you want to eat a sandwich?” is a totally useless question when you’re asking someone who’s been taught to interpret this as a command. Which a lot of people have been, because they’re in the power of people who don’t want to perceive themselves as having power over others. So they use lots of things that *look* like questions and polite requests, but aren’t.

And people get really, really good at correcting identifying orders and giving every outward appearance of consent. Because that dynamic punishes everything else.

So you have to do it differently. You have to make more guesses (not the right word, but don’t know a better one). And you also have to ask questions differently. You have to ask in a way that *doesn’t* suggest an answer. And you have to remind people that saying no is possible. For instance “Do you want to watch TV now, or do something else?” is better than “do you want to watch TV now?”, but still probably not good enough. 

But you have to notice this. And take it into account when you interact with people. I know some of my followers on here know more about how to do this than I do – comments anyone?