In a new 2023 overview on Autism, ABA for autism has been on 'a weak effect', and that comorbidities are widespread across the NDD spectrum.
In a new 2023 overview on Autism, ABA for autism has been on ‘a weak effect’, and that comorbidities are widespread across the NDD spectrum.
The short answer is, that Applied Behavioral Analysis (ABA) approaches autism as a behavioral disorder with behavioral performance deficits, that is caused by an inability or unwillingness to ‘act appropriately’ or ‘as demanded’ by societal norms.
As is the same case with the Neurodivergent Movement and their efforts to ‘normalize’ persons with autism, mostly for their own selfish reasoning in regards to ‘societal standing’ and ‘optics’, in my opinion. so is the case with ABA therapy.
The heart of the problem is, that both the Neurodivergent Movement and the ABA Community both have a fundamental flaw in their understanding of what autism is, does, and is caused by!
Therefore their efforts to ‘help’ persons with autism are of on the wrong foot, since they assume that the causality for the ‘unwanted behavior’ is – psychological – whereas the empirical evidence, in abundance, have shown that autism and all other NDDs are caused by – anatomical & physiological – defects in the expected genotypical functioning (what some call neurotypical), which causes a cascade of related symptoms of dysfunctioning.
The whole problem here is, that what ABA does is simply trying to ‘change the now’ with their techniques, unknowing that the behavior that they are trying to correct, is deeply rooted in the core brain functioning, and which is – nonconscious – for the person with autism!
The result is then, that all it does is to make the person with autism – fail – over and over again, until they just give up and ‘conform’ to the doctrine of ABA – while simultaneously sacrificing their individuality and subdue their ‘natural tendencies’.
This causes chronic physical and mental stress for the person with autism, since not only are they battling within, they are at the same time trying to cope with ‘societal norms’ and ‘people’s expectations’ – all of which they are unable to perform at the level dictated to them.
Personally, I have had therapy sessions with more than 50 adult women with late-diagnosed autism, and I can report back that 80% of them suffers from ComplexPTSD due to a tough life lived trying to ‘mask’ their problems, and meanwhile blaming themselves for their inadequacies. You can read my full research report here: Research: Ny dansk undersøgelse af voksne med ADHD og Autisme! (addspeaker.net)
... autism is characterized by a greater weighting of sensory information in updating probabilistic representations of the environment. Here, we unpack further how the hierarchical setting of Bayesian inference in the brain (i.e., predictive processing) adds significant depth to this approach. In particular, autism may relate to finer mechanisms involved in the context-sensitive adjustment of sensory weightings, such as in how neural representations of environmental volatility inform perception. Crucially, in light of recent sensorimotor treatments of predictive processing (i.e., active inference), hypotheses regarding atypical sensory weighting in autism have direct implications for the regulation of action and behavior. Given that core features of autism relate to how the individual interacts with and samples the world around them (e.g., reduced social responding, repetitive behaviors, motor impairments, and atypical visual sampling), the extension of Bayesian theories of autism to action will be critical for yielding insights into this condition. (Palmer et al., 2017)
... Bayesian inference is grounded in its neural instantiation-namely, predictive coding-many features of autistic perception can be attributed to aberrant precision (or beliefs about precision) within the context of hierarchical message passing in the brain (Friston et al., 2013). Here, we unpack the aberrant precision account of autism. Specifically, we consider how empirical findings-that speak directly or indirectly to neurobiological mechanisms-are consistent with the aberrant encoding of precision in autism; in particular, an imbalance of the precision ascribed to sensory evidence relative to prior beliefs. (Lawson et al., 2014)
To be fair, let’s take a look at what ABA is defined as …
Applied Behavior Analysis (ABA) involves many techniques for understanding and changing behavior:
Positive reinforcement is one of the main strategies used in ABA. When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change. First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more. Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.
A-B-Cs: Antecedent, Behavior, Consequence: Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program. The following three steps – the “A-B-Cs” – help us teach and understand behavior:
Looking at A-B-Cs helps us understand:
Planning and Ongoing Assessment: A qualified and trained behavior analyst (BCBA; board-certified behavior analyst) designs and directly oversees the program. They customize the ABA program to each learner’s skills, needs, interests, preferences and family situation. The BCBA will start by doing a detailed assessment of each person’s skills and preferences. They will use this to write specific treatment goals. Family goals and preferences may be included, too. Treatment goals are written based on the age and ability level of the person with ASD. Goals can include many different skill areas, such as:
The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (e.g. imitating single sounds) to more complex (e.g. carrying on a conversation). The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress toward goals on an ongoing basis. The behavior analyst regularly meets with family members and program staff to review information about progress. They can then plan ahead and adjust teaching plans and goals as needed.
ABA Techniques and Philosophy: The instructor uses a variety of ABA procedures. Some are directed by the instructor and others are directed by the person with autism. Parents, family members and caregivers receive training so they can support learning and skill practice throughout the day. The person with autism will have many opportunities to learn and practice skills each day. This can happen in both planned and naturally occurring situations. For instance, someone learning to greet others by saying “hello” may get the chance to practice this skill in the classroom with their teacher (planned) and on the playground at recess (naturally occurring). The learner receives an abundance of positive reinforcement for demonstrating useful skills and socially appropriate behaviors. The emphasis is on positive social interactions and enjoyable learning. The learner receives no reinforcement for behaviors that pose harm or prevent learning.
ABA is effective for people of all ages. It can be used from early childhood through adulthood!
What is the evidence that ABA works? ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association. “Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. ABA therapy includes many different techniques. All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior). More than 20 studies have established that intensive and long-term therapy using ABA principles improves outcomes for many but not all children with autism. “Intensive” and “long term” refer to programs that provide 25 to 40 hours a week of therapy for 1 to 3 years. These studies show gains in intellectual functioning, language development, daily living skills and social functioning. Studies with adults using ABA principles, though fewer in number, show similar benefits.
Source: Autismspeaks.org
The latest science points to a paradigm shift in how we understand Neurodevelopmental Disorders (NDDs), since overwhelming evidence in both genetic and neuroscience research now have shown, that there is more reasoning in think of a continuum of presentations instead of primary diagnoses with comorbidity (e.g., 40-70% with autism also have ADHD, and 80% of all with an NDD suffers from a Sleep-related disorder).
In the graphic here, I have tried to visualize how one such continuum might look like. Each quadrant is a presentation of a set of symptoms that points to a clinical diagnosis of a certain kind, while I’ve put NDDs in the middle and used a gradient colour-pattern to exemplify how each of the conditions interlocks with each other, rather than become distinct, separate conditions.
This review suggested that the outcomes of socialization, communication and expressive language may be promising targets for ABA-based interventions involving children with ASD. However, significant effects for the outcomes of general symptoms of ASD, receptive language, adaptive behavior, daily living skills, IQ, verbal IQ, nonverbal IQ, restricted and repetitive behavior, motor and cognition were not observed. The small number of studies included in the present study were limited in the ability to make inferences when comparing ABA, ESDM, PECS and DTT interventions for children with ASD and investigating the strengths and weaknesses of each type of intervention in terms of important outcomes. More methodologically rigorous researches will be necessary to ascertain the precise potential of ABA-based interventions for children with ASD. (Yu et al., 2020)
Thus, currently, there is inadequate evidence that ABA-based interventions have better outcomes than standard care for children with ASD on receptive language, adaptive behavior, and cognition. (Yu et al., 2020)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265021/
Fernell, E., & Gillberg, C. (2023). Autism under the umbrella of ESSENCE. Frontiers in Psychiatry, 14. https://doi.org/10.3389/FPSYT.2023.1002228
Lawson, R. P., Rees, G., & Friston, K. J. (2014). An aberrant precision account of autism. Frontiers in Human Neuroscience, 8(MAY). https://doi.org/10.3389/fnhum.2014.00302
Palmer, C. J., Lawson, R. P., & Hohwy, J. (2017). Bayesian approaches to autism: Towards volatility, action, and behavior. Psychological Bulletin, 143(5). https://doi.org/10.1037/bul0000097
Yu, Q., Li, E., Li, L., & Liang, W. (2020). Efficacy of Interventions Based on Applied Behavior Analysis for Autism Spectrum Disorder: A Meta-Analysis. Psychiatry Investigation, 17(5), 432. https://doi.org/10.30773/PI.2019.0229
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