See how Dr. Friman’s call for for compassionate care dovetails nicely with Dr. Hanley’s Perspective on Today’s ABA.
A Perspective on Today’s ABA from Dr. Hanley
This is today’s ABA when starting therapy with an autistic person, especially one who routinely engages in problem behavior.
Today’s ABA (applied behavior analysis) is about continually learning about the predilections of the autistic person being served so that preferred learning contexts can be developed en route to developing skills that can be appreciated by the autistic person as well as others. What follows is a guide for those implementing today’s ABA but written for those who are curious about what today’s ABA involves.
Learn by listening.
Ask the autistic person and/or ask people who know and love the autistic person about what he/she/they loves and hates. Be sure to review the love, aversion, and indifference towards activities, objects, furniture, contexts, and especially social interactions. Ask that person about the autistic person’s voice. How do they routinely communicate? And, especially, what are they communicating with their problem behavior? In other words, today’s ABA starts with asking questions, listening, and learning about the autistic person by people who know and love the autistic person.
Learn by creating joy.
From that conversation, put together a context in which the autistic person will be happy, relaxed, and engaged, one in which they will feel safe and in control. Enrich this space with all of the objects and activities that they love. Don’t be stingy with the stuff–more is better. Be sure to include all the things that they have lost in the past because they could not handle their removal or because they engaged with them in unique, stigmatizing, or disruptive ways.
Do not restrict in any way their freedom to do or move. Keep the door open. Follow their lead, physically and conversationally. Let the autistic person bring other materials to this context, remove materials from this context, reposition objects and people in this context, and essentially redesign it with either their actions or words.
Be sure to create clear signals of your submission (i.e., remove all signals of dominance—hovering too close or standing above them). During this time, avoid all acts of redirection, prompting, teaching, questioning, and language expansion. Be 100% available to the autistic person but do not add your “two-cents” to the situation unless asked. Reserve even praise unless the autistic person initiates by sharing what they are doing or just did with you and you are authentically impressed. Do not supervise the experience; share in it without taking it over in any way.
Respond to all attempts to communicate–this will happen the sooner you stop trying to lead the situation. Help them, for instance, not when they struggle, but when they indicate they would like assistance. Be earnest in your attempts to help even when you are not sure how to do so. Do not let any behavior towards you be ignored; react to their behavior in normal ways, just do not attempt inspire the next interaction—let them lead.
Continue revising the context and your manner of interaction until the autistic person does not want to be anywhere but there. Let them “vote with their feet.” Besides being dignifying and avoiding regrettable physical management, allowing them to leave the space provides good information. Leaving means something important is missing or something aversive is present. Keep working on building and refining the context until the autistic person is happy, relaxed, and engaged for an extended period. Recognize that happy, relaxed, and engaged looks very different for different autistic persons, which is why it is essential that someone who knows and loves the autistic person is present at this and the next step of the process.
In sum, teach the autistic person that you know them, you see them, you hear them, and you are there for them. This is the first and crucial step in today’s ABA.
Learn by empowering.
After you are confident that you can create a safe and engaging context and there is zero probability of any severe problem behavior in this context, it is time to empower the autistic person further and establish trust between you and the autistic person. It starts by clearly signaling that the prevailing conditions are about to change, and for the worse, but be clear and kind about it. Through normal actions and words, make it clear to the autistic person that you would like them to stop what they are doing, set aside their materials, move in a different direction, inhibit any self-stimulatory behavior, and transition to an area in which developmentally appropriate instruction/expectations will commence. Be sure this area of high expectations is set aside to some extent and populated with all the challenging activities and expectations reported by those who know and love this autistic person as important for his/her/their development.
If the autistic person shows any explicit sign of distress, discomfort, or protest in the form of either minor or severe problem behavior while transitioning from essentially their way to your way, acknowledge it immediately and relent. Let the autistic person return to their way and resume following their lead until he/she/they gets back to their version of happy, relaxed, and engaged for a short period.
Repeat this process until it is obvious that the autistic person is empowered and understands that they do not need to comply against their will and they do not need to escalate to escape or avoid the things they don’t want or obtain the things they do want. Teach them that you see them, hear them, and understand them even more now, despite the sometimes lack of precision or general acceptability of their communication. Teach them to trust you. In this period, be clear, be alert, be quick, and be consistent. From this resetting of the relationship, you will eventually restore balance and be able reintroduce the ambiguity and challenges of life without problem behavior returning.
Learn while teaching.
The path to a joyous lifestyle for families with autistic persons is paved with skills. The big pavers are play/leisure skills, communication, toleration, and cooperation. Once these are set, the branching paths are endless. Today’s ABA process continues by replacing the behavior revealed in the empowerment phase with an easier one that will be better received by others. The process involves gradually introducing ambiguity as to whether the new communication skill will work and by stretching the periods of cooperation. The pace and aims of this treatment process are continually informed by feedback provided by the autistic person, both in terms of what they say and do. Gone are the days of working through problem behavior and negative emotional responses—those are indictors that the treatment process needs to be adjusted, and not at the team meeting, but at that moment.
This treatment process is one in which the starting point is a happy, relaxed, and engaged autistic person. The themes of I see you, I hear you, I understand you, and I am here for you persist throughout the entire process. It bears repeating that there is no obligation to teach while children are upset in any way or under any duress. Hasty efforts at promoting compliance or assessing the developmental status of an autistic person are not championed in this process. That which is championed is establishing trust, engagement, authenticity, and agency. Cooperation in shared experiences follows. Acknowledged in this process is that skills will be learned both during therapist-, teacher-, and parent-led times as well as during times in which the autistic person is leading. Also recognized is the understanding that developmental assessment is best undertaken once trust and persistence in difficult tasks has been established.
Today’s ABA is trauma-informed. It is to be assumed that any person in the care of a behavior analyst for problem behavior has experienced multiple adverse events, with many exceeding the criteria for acknowledging that trauma has been experienced. By learning through listening; by enriching therapeutic contexts; by building and maintaining trust; by following one’s lead; by relying on personalized contexts in which people are happy, relaxed, and engaged; by listening to communication bids; by not working people through noncompliance or emotional duress; by allowing people to walk away; by making decisions based on performance; and by teaching from joy; today’s ABA is trauma-informed.
Our world, our country, and yes, our little field of ABA are at all at their own crossroads. The time to reconsider the status quo is now, whether it be as mundane as how to work in an office and socialize in restaurants or as profound as dismantling systemic racism. Our issues in ABA are somewhere in between but I daresay that our issues share challenges associated with getting back to work in the midst of the coronavirus and addressing injustices for people of color, especially black people in America. Let’s learn from others, especially those expert in public health policy, human rights, and criminal justice as we make our way. But let us not wait any longer to get on the right side of history.
Ours is not to dominate but to de-escalate or better yet prevent escalation in the first place. Ours is not to coerce (thank you Murray Sidman!) but to listen, learn, guide, and coach. Ours is not to redirect, restrain, or merely manage and modify. Ours is to understand, share, and shape. Ours is to prioritize safety, rapport, and the televisibility of what we do above all else. We have proven that meaningful outcomes can follow when we prioritize these things (see http://www.practicalfunctionalassessment.com ).
To those who do not know this as ABA or who downright despise ABA: I hear you and I understand where the confusion or hatred comes from. I acknowledge that our field has been associated with wrongs on its journey of helping autistic people and members of underserved populations (i.e., those with intellectual disabilities). Our collective attempts at helping are better now than they were, and both research and practice reveal to me that behavior analysts doing better is continuing. I also recognize that improvement is not inevitable just because we embrace a form of scientific method. Values-based movements have been displaced from ABA in the name of science for as long as ABA has been in existence. This is a sad and uncomfortable truth, but one within our power to address if we listen to the voices of dissent that have been marginalized for too long.
ABA has the potential to inflict trauma, and it has the potential to alleviate trauma. I don’t want to wait for some horrific incident being recorded for fundamental change to take place. I have been attempting to correct my mistakes and improve the way I do ABA through research, authentic practice, consulting, and especially listening to other voices outside my choir for many years. I won’t make excuses for my behavior or that of other BCBAs. I simply apologize. I apologize for not doing more, saying more, pushing more, or disrupting more. Consider this a step in the direction towards self-awareness, improvement, transparency, accountability, and an obvious commitment to protecting the rights of those we serve. I hope you will join me on this quickening walk towards a more perfect ABA to help families of autistic persons whose lives are negatively impacted by problem behavior.
* Thanks to Dr. Anthony Cammilleri for his suggestions and encouragement with respect to this paper.
*For translated versions of this Perspective Paper, please click here.