Monday, April 24, 2017

More thoughts on ABA (from the trenches)

Every year or so, I see the same old blog posts making the rounds, and, invariably, someone asks me what I think about them.

Every year I sit quietly.

There's this thing, when you're a special needs parent and a behavior analyst. They both pervade your very being. Sometimes the mama bear takes over. Sometimes the BCBA is who is in charge. Usually it's a combination of the two. And when these blog posts, claiming that applied behavior analysis (ABA) is terrible and abusive and awful come across my feed, I have two thoughts every time:

They're not wrong.

Also, they're not right, either.

I didn't always feel that way. Prior to my two kids, Dax (nine, med frag, intellectually disabled child evil genius) and Ty (seven, diagnosed with classic autism at three, super handsome) I'd have told you they were ridiculous. I didn't get it, not the way a mother does. Now I do.

There have been countless times in the past nine years that I've had to take off my BCBA hat completely and just be a mom, because there are things a mom can see that ABA can't. There have been other times I've had to step back and try to look at my kids through the lens of ABA because there are things a BCBA can see that a mom can't. We all have on blinders. It's really hard to take them off.

ABA helped us through oral aversion, food refusal, head-banging. It helped us learn sign language, then verbal approximations, and then verbal language. But it was the mama in me that has picked up on the tiny nuances through the years. It's the mama in me who recognizes those tiny changes in behavior and mood that are so indicative of internal things. Mamas see those things when no one else does. And people think we're crazy, but we know. People can just keep on thinking we're crazy, because we KNOW.

But here's the thing. These blogs that circulate often focus on ABA not addressing internal behaviors. BCBAs don't address emotions, not the way a therapist does. BCBAs don't search for the internal causes of behavior. That's all true for the most part. Because that's not what we do. Do you get equally as mad when you go to the dentist and he doesn't address your vision? Because ABA is built on the foundation of using scientific principles to increase and decrease observable behavior. That's what we do. If you want to increase or decrease behavior, call a behavior analyst. If you want to address emotions and feelings, call a therapist.

I will put some of the blame here on us as a field. We are, as a profession, pretty sure we could fix anything given enough time, control, and resources. We get a little over-confident sometimes, mostly because we like to think having a science to our methods makes us superior to fields who don't. We ethically have to rely on data, not just what feels good, and we like data and graphs and proof, and that's what we do. As a field, we need to work on referring out to other fields more often, but we like to work on everything our way. It's a behavior we need to increase.

Which brings me to my next point: applied behavior analysis IS a science. There are decades of peer-reviewed research showing that ABA IS effective at changing behavior. The science is good. The science is real. The principles of behavior analysis are active in your life every single day. It explains your routines. It explains your bad habits, and your good ones. Not believing in ABA, which I see commented quite frequently, isn't really a valid option. ABA is as real as gravity. Applying the principles, however, is only as good as the practitioner. Therein the fault lies.

I look back sometimes at "pre-kid" Mollie the BCBA and I cringe. I thought I knew all the answers. I thought external behaviors were all that mattered. I apologize. I was really smart back then, but there was so much I didn't understand. Now I spend more time learning than I do trying to be smart. I'm still learning. Bear with me. But, for every mistake I've made as a practitioner, ABA was never at fault. It was me. But, here's what I do know now that I'm a dinosaur: if the practitioner is  not focusing on the (observable) behaviors that are important to you or your loved one, say something. We have an ethical obligation to address the behaviors that are socially valid to the people we serve. But, we don't know unless you tell us. Remember, we like observable behaviors. We do better with that than someone hiding their anger behind a smile and pretending like everything is okay. So, tell us. Also, we have to have your consent before we implement a behavior plan. If you aren't comfortable, or if you don't understand the reasoning, or if you just don't like it, please, tell us. Out loud. Use your words. And if your behavior analyst isn't meeting your needs, tell us. Ask for a referral. Ask for a discharge. Your goal, and the BCBA's goal, are the same. Everyone wants quality of life, life satisfaction, happiness, and met potential, but we might have different ideas of how to get there. If you can't reconcile yours and the BCBA's methods of getting there, maybe ABA is not the right fit for you. Because, really, families and lifestyles and core beliefs are just as varied as the clients we serve. Everyone has the right to choose the path that works for their lives. Sometimes that's ABA. Sometimes it's not. You have the right to choose just like the next guy.

I love ABA. I do. I can't help it. It is a quintessential part of who I am, and a huge part of how I parent and interact with the world. (But it's not the only way I see the world.) I'm sorry to everyone who's had a bad experience. I read these accounts of how painful eye contact is, or how sessions felt like dog training, and I am so sorry. But, for every bad experience, there are so many good experiences. The "dog training" methods are what taught my sons to talk. They're what helped teach my older son to eat and walk. They're why my kid with a chunk of brain missing is almost at grade level (albeit he's been proactively held back a time or two.) They're why my seven-year-old with autism can now identify foods he can eat with his celiac disease diagnosis and prepare meals and tell me when he's sick and tell me why he's frustrated. And they're happy. Oh my god, they're such happy, amazing, brilliant little boys. And I adore them and would never do them harm, and I want what is best for them which is why I use ABA principles every single day of their precious little lives, and will continue to as long as the mama in me agrees that it's the best course of treatment for them and as long as they keep learning and growing and thriving. I can't say ABA is right for your family, but you can't say it's not right for mine.

I wish I could fix it all. I wish there was some blood test we could run that would tell us exactly what a person needs and when and how much, and then I wish insurance would friggin' pay for it. I wish we knew more. I wish it was easy. I wish any of it was easy. It's not. We all do the best we can with what we've got, and sometimes that's scary and lonely and difficult. And your experiences are your experiences and mine are mine, and we're all trying to figure it out as we go. So, keep talking and keep sharing, good and bad. Be a voice. Keep on keeping on. Keep learning and keep teaching. And let's all keep trying to fix the world the best way we know how.

***Edited to add:

We do address emotions in ABA, we just have to do it in a measurable way. It's not the traditional "talk" therapy so many people expect. With my own kids, that looked like when one of the boys would get frustrated, I'd mimic the facial appearance and say, "You're frustrated. I'm frustrated, too. You're frustrated because this is hard. I understand, Can you say, 'I'm frustrated'?" Sometimes it was baby steps to the next level, but at seven and nine they are now able to tell me exactly how they are feeling. I hope that clarifies that point just a little.


Claire Ellis said...

Mollie for president. #2020

Anonymous said...

ABA does address emotions and feelings! Look into Relational Frame Theory (RFT) and Acceptance and Commitment Therapy (ACT). Even Skinner wrote about covert behaviors :)

Only the Sheppards said...

Claire! Thanks but no thanks ;)

Anon: I probably should have clarified that better, but I added an edit to address it. By "emotions and feelings" I was referring more to the touchy-feely side of it. My BCBA hat was on while I was writing.