A very concerned mom recently contacted Dr. Jacob Boney, owner and clinical director of Scottsdale Pediatric Behavioral Services, regarding her uncertainty about whether ABA is safe for her child. Her actual question was:
“Is ABA safe for my child? I’ve heard some horror stories, recently, about kids being punished, restrained, secluded and even being denied of basic rights, like food and drink. I’ve heard that children can be allowed to just scream and cry for hours and that no one will even try to comfort them. I’ve even read a recent article by an ABA therapist that said that she felt like she was paid to abuse children. I’m very scared and uncertain if ABA is the right choice for my kid. Can you help explain this and what I should do as a mom?”
This is a question that Dr. Boney was eager to address because a lot of parents have these same misgivings without expressing them. Unfortunately, some of these concerns may be true about some providers, and some of it was much more true in the past. Historically, ABA was used to treat patients in mental institutes and hospitals and a lot of that treatment focused on behavior reduction, which relied mainly on punishment procedures. Because of that, ABA got a bad reputation for being overly aversive and punishment-based.
In the past 20 years or so, ABA has made a big shift toward being more function-based and more reinforcement-based. Currently, ABA is ethically required to do functional assessments and to use evidence-based practices. However, it is true that some of these things did happen in the past and there may be some providers today that are not totally aligned with function and reinforcement based methods. This may, in large part, be due to the rapid growth of ABA in the last few years. The number of licensees in the state of Arizona, where Dr. Boney practices, has tripled almost every year. With that kind of growth, there can be a dilution of quality in providers.
All of that said, quality ABA is nothing like what has just been described. It is not abusive. It is not restrictive. It is not punishment-based. That is not what quality ABA therapy looks like, and if that is the kind of therapy that your child is receiving, parents are advised to stop that treatment, immediately, and look for a quality provider.
Why ABA IS Safe
ABA is data-based. Treatment is monitored very closely, on a daily basis. Because of this, whether something is or is not working will be known very quickly. Data is critical, and, because it is taken so meticulously and monitored it so closely, we can make finely-tuned adjustments in a very responsive way. Dr. Boney strongly believes that if a child is spending sessions crying or upset, they are not learning and are not going to make much progress. The program and treatment methods would need to be shifted quickly.
ABA is now well regulated. The current licensure system regulates and monitors the way ABA is practiced. This ensures and maintains a very high standard of practice.
ABA must be effective. There has to be a simultaneous increase in adaptive behavior and decrease in maladaptive behavior. Both must occur at the same time or good ABA is not happening.
Competent behavior analysts have specific decision protocols. This means that a specific action is called for after a certain number of things are recorded. For example, after an overall descending five data points, you are probably going to stop a program and make an adjustment or utilize what’s called a tactic. Decision protocols are extremely critical. They ensure that a change is made quickly so that they do not continue to do what is not working. This crucial component of ABA makes it much more safe and effective.
The focus on functional analysis has changed ABA treatment in the past 20 years and allows us to identify the function of problem behavior much more quickly and efficiently. An even more recent modification, called synthesized functional analysis, makes the process even quicker and more humane, as well as safer and more efficient. This has led to very specific, tailored, function-based treatment.
In the old days, behavior therapy basically focused on decreasing undesired behavior. Today, there is an ethical protocol called the “fair pair rule”, which requires that for every behavior that you decrease, you are ethically required to create a behavior to increase. That shifts the focus to increasing behaviors with reinforcement-based procedures.
ABA should be fun, engaging and extremely helpful for your child. Children who are in a good mood, happy and looking forward to their therapy sessions get far more benefit from treatment. This is one of the reasons that ABA is safe because making sure children are happy and naturally motivated is key to acquiring good data, which will more quickly lead to successful treatment.
Ethical guidelines require that the least restrictive interventions be utilized.
Behavior analysts are required to get ongoing training. Constant research is taking place in behavior analysis, and we are required to utilize that research and the latest evidence-based practices to benefit our patients in the safest, efficient and ethical way.
ABA is growing because it is effective. There is only one treatment that is approved by most insurance companies as one of the most evidence-based ways to work with children who have significant behavioral issues and developmental delays. That is ABA therapy.
Parents should develop a good relationship with their child’s therapist and not hesitate to seek information from them. Ask questions. Any competent provider should provide you with similar information so that you are confident that ABA is safe for your child.
Utilizing evidence-based practices and the scientific principles of Applied Behavior Analysis, the Scottsdale Pediatric Behavioral Services team provides assessment, treatment, and consultation for a wide range of behavioral issues. We work with a variety of children, families, schools, hospitals, mental health agencies, and local community organizations to provide these services. If you have any questions about ABA and how safe it is for your child or would like more information about any of the services offered by our team, please feel free to contact us by phone at 480.410.4040, email us at [email protected], or click here for our convenient online form.