BBC4 had a fascinating documentary this week on a new and controversial treatment for dealing with children with autism. Applied Behaviour Analysis (ABA) is a system of teaching started in the 1960s which stems from a reward and punishment approach that was developed from experiments with animals. It claims to reduce unwanted traits in children with the condition through a system of drawing attention to good behaviour and ignoring or not responding to negative actions. While this approach simply sounds at first to be nothing more than good parenting, ABA has split the autistic community down the middle. Many parents who put their children through ABA programmes swear by its effectiveness. But those who believe that autism isn’t so much a disability but a different way of the brain working disagree.
Watching the two camps articulately argue their cases, it is hard not to fit them into the old opposing social versus medical model of disability and like always I can see real validation in both points of view. I do not claim to be an expert in autism, it is one of the disabilities I find hardest to understand, although ironically I am told by close family members that my personality shares many traits recognised as symptoms of autism (I sometimes struggle with social cues and communication and am prone to obsessive thoughts and behaviours). I have friends who have been classed as being on the milder end of the autistic spectrum. What strikes me is that autism IS a spectrum of intensity of behaviour, just as Cerebral Palsy is a spectrum of physical and mental ability. No two people are the same.
I can fully understand the intense frustration for parents especially when they struggle to gain any meaningful communication from their children. It must be a very heart-breaking and lonely place to be, and the desperation to try anything that might work must be immense. But, as with the case of PETO in the treatment of those with disabilities in the 1980s, I would think it would be very hard to judge whether a child’s ability to develop skills such as language are indeed down to a course of intensive repetitive treatments, that can last for eight hours a day, or whether they would have picked up them naturally. Practitioners of ABA claim that the tantrums and adverse behaviour displayed by autistic children at the start of a programme when ‘unhelpful’ traits and habits are denied them will lessen over time as they no longer receive a response. But the question has to be asked how long is it acceptable to leave a child in distress before they learn that their behaviour is getting them nowhere. We know now the autistic brain is wired differently; that the channels of perception of information from the outside world take in stimulus in a way that is different from a ‘normal’ brain. The filters that many of us take for granted to block out much of the data flooding into us every moment of every day simply aren’t there, and many of the repetitive ‘ticks’ and habits are a self-formed method of comforting and a way of focusing the brain on one thing to form some sort of mental order in their world. It is many of these ticks that ABA works towards removing because they are seen by the wider society as unacceptable. I was struck when watching the programme by a scene that showed a young Swedish boy repetitively turning the pages of a book back and forth and his ABA therapist saying to camera this was not ‘productive behaviour’. While this maybe true, the question must be raised as to who does this behaviour actually hurt and whether, if the repetition gives the child comfort, does it have a purpose beyond that which we can understand? Are we, as a society, prepared to spend immense amounts of time and energy to mould autistic children’s minds into a set of pre-agreed social behaviours against their mental comfort and well-being? Is such behaviour on the part of adults a bit abusive when it is basically breaking someone’s will to make them become something they are fundamentally not? Many autistic adults gradually learn to lessen their ticks in public settings to conform but still maintain their way of seeing and reacting to the world as a fundamental part of who they are as a person. In fact, there are those who use their ability to focus and take in immense detail to achieve phenomenal feats in areas such as maths and art. Is it right to ‘cure’ such a way of thinking?
It is hard to knock ABA when you see the case studies in which it works. When you witness a child go through the programme and develop and improve you do feel good for not only them but for the relief seen in their parents. But any achievement comes at a cost. A cost of time and effort put in by parents, child and teachers to get the child to that goal and also the loss of seeing where the child’s autistic mind would naturally lead them. By making a child always have to submit to a behaviour decided by an adult in order to get approval and rewards rather than loving them for the person they are, you are perhaps leading them down a road of self doubt where they don’t develop the important ability to decide for themselves and say no.