PediatricDigest: Bridging the Gap: Listening to Autistic Voices in ABA

Emily Lopez, one of our Registered Behavior Technicians (RBT), and a current graduate student of Applied Behavior Analysis (ABA), discusses the importance of listening to Autistic voices in ABA and her personal experience with it as someone with Autistic Spectrum Disorder (ASD).

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Bridging the Gap: Listening to Autistic Voices in ABA

In recent years, there has been a great shift toward understanding and acceptance of autism. This increase is greatly attributed to autistic individuals and their families raising awareness, often through social media. Many autistic adults have used their platforms to share their lived experiences, and many have spoken about receiving therapy as children. If you've come across these conversations online, you may have heard criticisms of applied behavior analysis (ABA) and seen a divide between the autistic community and ABA professionals. This post will offer a different perspective from my lens as an ABA service provider and an autistic individual who received therapy as a child. I hope to bridge the gap between such concerns and parents and clinicians who want to support autistic learners.

Why Some Autistic People Criticize ABA—and Why It Matters
While ABA has helped many families and been life-changing for many autistic people, it also has some strong criticisms. If you're reading this, you likely support someone with autism in some way. It's important to understand these criticisms to ensure the best possible outcomes for those we advocate for. While I had a positive experience with ABA as a child, I recognize that other autistic people did not have the same experience, and some report long-term emotional harm from therapy. Although everyone has had a different experience with ABA, there have been some common criticisms reported by autistic adults (Anderson, 2022):

Therapy focused on teaching compliance over autonomy and self-advocacy.
Taught children to mask or suppress their autistic traits to appear "neurotypical."
Had long-term effects on mental health and self-esteem.

Building Bridges: How Parents and Providers Can Learn from Autistic Voices
It may be uncomfortable to reflect on these concerns. However, to collaborate effectively, we must foster dialogue without becoming defensive. Parents and providers can learn from autistic voices by listening to real-life experiences and being responsive to criticisms. More importantly, we need to listen to the individuals we support and include them in decision-making to whatever extent possible. Autistic people should have a say in decisions made about them, even if their involvement looks different.

Considerations for Centering Autistic Voices in Therapy
To center autistic voices, we need to involve the learner in therapeutic decision-making. Here are some practical ways to involve the autistic person in therapy. As I mentioned previously, involvement looks different for everyone. This is not a protocol or checklist for centering autistic voices, but some considerations and points of reflection.

Are we being transparent with the learner about their challenges and support needs?

For myself and many other autistic individuals, open and transparent communication is essential. Some autistic adults who received ABA services have shared that they were never told that they were in therapy or why, which was confusing and harmful for them (Anderson, 2022). I encourage you to help de-stigmatize autism by being open with autistic learners about their diagnosis, challenges, and support needs.

Is the learner involved in selecting therapy goals?

We should be selecting goals that are meaningful and align with the learner's values. If appropriate, we may ask the learner what they want to achieve or prioritize during their time in therapy. We may also observe the learner's behavior and family values to determine which goals are most important to them. When selecting goals, one strategy is to check the motivation for designing that particular goal. Am I selecting this goal because it is important to the learner? Who will benefit from teaching this skill?

Are we prioritizing the learner's assent and autonomy?

A general guideline is to prioritize the learner's assent as much as possible. A significant criticism of ABA is the use of procedures that do not respect the individual's autonomy. If we are centering the client, we shouldn't just respect their autonomy but teach self-advocacy and equip them with the skills to communicate their assent and withdrawal of assent. In cases when the procedure is necessary, such as in instances with risks of harm, we should allow the learner to exercise their autonomy to the maximum extent possible. I suggest reading Morris (2024) for more information on assent.

Are we embracing individuality?

As an autistic person, I can personally attest to the harm caused by masking or hiding my autism to fit in. Appearing "neurotypical" should never be the goal. To center autistic voices, it is important to not just allow the learner to express their autistic traits or behaviors but to embrace and encourage them to be themselves. Again, our therapy goals should be meaningful to the learner. We should be teaching skills that will give learners more opportunities to access what is important to them.

How ABA is Evolving to Better Support Autistic Individuals
Although there is still plenty of room for growth, I am encouraged by the progress I've seen among those who support autistic learners. Involving autistic individuals and their families in decision-making processes is a crucial part of the evolution of ABA. Whatever your role—parent, therapist, educator, or friend—remember: autistic voices deserve a seat at the table.

References
Anderson, L. K. (2022). Autistic experiences of applied behavior analysis. Autism, 27(3), 737–750. https://doi.org/10.1177/13623613221118216

Morris, C., Oliveira, J. P., Perrin, J., Federico, C. A., & Martasian, P. J. (2024). Toward a further understanding of assent. Journal of Applied Behavior Analysis, 57(2), 304–318. https://doi.org/10.1002/jaba.1063