In the late 1960s and 1970s, a disability rights movement emerged in the UK and US, which rejected the medical view of disability, and posited that disability is a characteristic similar to others such as race and sex. (Graber and Graber, 2023). The disability rights movement rejected a “bad differences” view of disability and embraced a “mere differences” view. More recently, the neurodiversity movement has arisen with a more specific focus on “neurodiverse” persons, including people with autism. Like disability rights advocates, neurodiversity advocates oppose the medicalization of disability and argue that disabilities, such as autism, are not pathological, but simply different.

This is not to argue that autistic people do not have challenges that make their lives harder than those of neurotypical people. Rather, neurodiversity advocates locate the source of the difficulties experienced by autistic individuals in the mismatch between people with autism and the environment. More specifically, they argue that the medical model locates the problem within autistic people, rather than in the interaction between autistic people and environmental demands and constraints that are suited to the needs and abilities of non-autistic people.

Given the prominence of Applied Behavior Analysis (ABA) as an autism treatment and the fact that ABA services are primarily funded through insurance and legal mandates to cover it as a health service, it is not surprising that ABA has been associated with the medical model of disability by neurodiversity advocates. In the past 5 to 10 years, critiques of ABA in blog posts and online forums have featured a variety of concerns expressed about the safety and ethics of ABA interventions; these concerns have also been expressed in peer-reviewed literature about autism and ABA. Neurodiversity advocates have argued that the number of hours of ABA services is excessive, particularly for younger children, and that the use of aversive stimuli and consequences is harmful. Some individuals with autism who had ABA services have stated that they have had PTSD and even suicidality from the experience.
In their article, Applied Behavior Analysis and the Abolitionist Neurodiversity Critique: An Ethical Analysis, Graber and Graber note that while some neurodiversity advocates argue for ABA reform, others reject the idea that ABA can be reformed, and argue instead for ABA abolition. The authors focus primarily on the arguments of the ABA abolitionists, including the assertion that ABA treats “neurotypical behavior as the benchmark for success,” and in so doing, makes autistic people more acceptable to others rather than actually helping them. Abolitionist critics of ABA also assert that it treats the behaviors of neurodivergent people as “inherently bad or problematic.”

Graber and Graber discuss the assertions of ABA abolitionists in relation to 3 hypothetical case studies, including a case of repetitive self-injurious behavior (SIB) leading to bruising and sometimes, open wounds; hand-flapping in school that might be interfering with academic progress; and, hand-flapping at home that does not interfere with progress towards academics or social milestones, but is nonetheless a concern for parents who have repeatedly requested a reduction intervention.

Graber and Graber assert that the abolitionist critique has little application to self-injurious behavior. The question raised is whether treatment that is consistent with ABA intervention could be effective at reducing or eliminating SIB. Approaches associated with clinical psychology, such as dialectical behavior therapy (DBT), have been cited by critics of ABA as more appropriate for treating SIB. However, DBT shares a lineage with ABA, including a basis in the same theoretical principles. The authors do not comment on the fact that individuals who are more heavily impacted by autism may be non- or minimally-verbal, and are unlikely to have the skills to participate in DBT or other interventions under the umbrella of cognitive behavior therapy. Critics of ABA have also asserted that treatment designed to help people “functionally communicate, tolerate frustration, and regulate their emotions” is needed to intervene on SIB. Functional communication training (FCT), however, is a widely used intervention derived from ABA research and based on the literature on the functions of problem behavior. The authors conclude that the neurodiversity critique of ABA as it applies to SIB more regards “the forms and methods of ABA practiced, rather than a call to abolish all forms of treatment of SIB that could be consistent with ABA.” They note that treating SIB with ABA-derived or consistent approaches is compatible with the disability rights perspective and the abolitionist neurodiversity critique, and further that the case of SIB is particularly important because it “highlights the limits of the abolitionist neurodiversity critique” which they assert “is not sufficient to make the case for the abolition of ABA.”

Graber and Graber note that the two case histories of hand-flapping are “more problematic” in the abolitionist neurodiversity critique. Hand-flapping in school is problematic in this framework because curricula design and physical classroom environments are not inclusive of neurodivergent behaviors such as hand-flapping. Proponents of the neurodiversity approach would argue that these factors be modified to be more inclusive of hand-flapping rather than hand-flapping eliminated. The authors also address the normative assumptions about the rate of learning, noting that expectations about the rate of learning are based on the rate at which neurotypical students learn. However, the authors assert that while ABA interventions to reduce hand-flapping “might treat neurotypical behavior as normative, it need not treat hand-flapping as pathological.” Thus, intervening in the behavior does not rest on the assumption of a pathology, but rather on the observation that the behavior interferes with learning, just as texting in class, a behavior that neurotypical peers might engage in, would interfere with learning. Graber and Graber go on to support the assertion that treating hand-flapping as a pathology “is morally problematic” and akin to treating someone’s race or sexual orientation as a pathology.

Hand-flapping in private, with no impact on academic achievement or social outcomes (e.g., no stigma), is described by Graber and Graber as “the most vulnerable” of the three case histories to critique. The authors essentially have no argument with the abolitionist neurodiversity critique with regard to this scenario and do not endorse treating the behavior as a pathological trait or the child as in need of recovery from autism. They note that the parent’s motivation for requesting intervention “is unclear,” unless they believe it is wrong or pathological.

Graber and Graber continue their discussion of ABA and the abolitionist critique with a fascinating discussion of teaching approaches to linguistic diversity in the classroom, e.g., approaches to teaching Standard English (SE) in classrooms with students from diverse linguistic backgrounds, including African-American Vernacular English (AAVE). The literature in this area has focused on both additive and subtractive models of teaching. These are relevant to the ABA abolition discussion because of the behavioral dimensions of adding new skills (i.e., Standard English) to an existing behavioral/linguistic repertoire, without eliminating students’ existing repertoires (additive model) versus eliminating students’ existing repertoires and replacing them with standard English (subtractive model). This analogy serves to provide behavior analysts with a perspective on neurodiversity and behavior analytic interventions that seek to teach autistic clients how to navigate the wider environment, which is more suited to the characteristic behaviors of neurotypical people. This perspective utilizes the mechanism of “code-switching,” which essentially allows speakers of AAVE who have also mastered SE to function in different types of environments, accessing reinforcers and avoiding punishers in each of them. The additive model respects the speaker’s “home language” while teaching him or her a second linguistic repertoire to increase adaptability and opportunities. An analogous approach to teaching autistic people can allow them to “code-switch,” and therefore access the benefits of the “neurotypical environment” while respecting that their behavior at home or in spaces with other autistic people can and perhaps will be different.

Graber and Graber continue by applying the additive model to the three ethical scenarios discussed earlier in the article, as well as concrete implications for ABA practice, including discrimination training to teach autistic clients when it is contextually appropriate to engage in certain behaviors. Due to the seriousness of the abolitionist critique of ABA, the ethical discussion is timely and important for ABA practitioners. If you are interested in the full article, a free download is currently (10/2/2023) available here: https://link.springer.com/article/10.1007/s40617-023-00780-6

Graber, A., Graber, J. Applied Behavior Analysis and the Abolitionist Neurodiversity Critique: An Ethical Analysis. Behav Analysis Practice (2023). https://doi.org/10.1007/s40617-023-00780-6