ABA for Autism: Unsupported and Under the Radar
by Rebecca Flynn
Hi, I’m Beck, and I’m an ABA therapist.
ABA stands for Applied Behavioural Analysis. Through ABA, I work with children on the autism spectrum to teach them all kinds of skills. You may have heard about ABA, or even seen one of the American documentaries that give an incredibly negative impression of this form of therapy. It was developed originally in America to “train” autistic children to repeatedly follow instructions for a reward; do the thing, get a reward, do the thing, get a reward.
However, since finding its way to the UK, ABA has developed into something totally different. Of course, ABA therapists still fundamentally reinforce a child’s positive behaviour (do the thing, get a reward), however the framework and play elements are totally child-led. The combination of clear learning expectations, helpful tools and visual aids, as well as space for fun and down-time, are, in my experience, massively beneficial.
More and more parents are turning to ABA, realising that it’s not the inhumane training scheme that it’s traditionally portrayed to be. ABA therapy isn’t about controlling children or making them all uniform; it helps them cope with the unspoken and often confusing structures of the neurotypical world.
Unfortunately, many of the autistic children I work with struggle to move through this world. They fall on the more severe end of the spectrum, and may never be able to work in paid jobs, enjoy romantic relationships, or have a family. Because of this, they’re never given the chance that neurotypical children are given to learn new things and develop. As far as society is concerned, they don’t have the potential to grow. But I wholeheartedly disagree.
I have worked with children whose families were told by doctors, schools and local authorities that they could never achieve certain things. Those families turned to ABA, and together we defied all expectations.
A doctor told one family I worked with that their child would never understand how to use a toilet. It took us only 2 weeks to teach him. Through ABA, we have helped a child use imitation skills to perform in a school play, and in just 3 months, we had a child telling the time using analogue and digital formats for the first time in all their years at school.
I have taught reading, writing, independent shopping, and road safety. Most crucially, I have helped reduce self-harm behaviours, and encouraged a child to make friends through teaching important social skills such as frustration tolerance, empathy, and more flexible ways of understanding and relating to others.
I’ve been doing this for about 5 years now, and I have always seen progress in my students. As far as I’m concerned, there is no other educational technique that can be adapted to the child as they develop and learn. However, ABA is seriously unsupported by the government and the NHS.
Families of autistic children are getting themselves into debt by taking on local authorities and going through tribunals, especially now that getting an Education, Health and Care Plan is more difficult during the coronavirus pandemic. I have witnessed the parents I work for in distress, having lost their funding and unable to pay for more hours of ABA while their case is waiting to go to appeal.
If parents of autistic children do happen to have money for court fees (and energy left over from caring for their families and going to work) they may be able to claw a support package from the council for ABA. But even then, they’ll have to fight to keep this support every year at an annual review. It’s exhausting, and it doesn’t stop there.
The families who can afford ABA at home still find that their child’s learning is hampered at school. Few schools will hire ABA therapists, because their qualifications and training mean that they cost more than standard teaching assistants. But for ABA to work, it’s all about consistency.
For example, take a child who could benefit from learning emotional regulation. Neurotypical children tend to learn how to express and cope with their emotions through their parents’ response to their emotional states. Autistic children are not always equipped with the same capabilities for regulating their emotions. Using ABA techniques, I can help break down the skills they need and teach them gradually, using positive reinforcement to encourage the child to remember and use what they’ve learned until it is habitual. As the child learns, the praise given by their parents and carers becomes an intrinsic reward, and eventually less tangible and immediate reinforcers are required.
The same applies for any skill. By rewarding certain behaviours with something the child likes, you can help them manage scenarios and tasks that previously seemed impossible. In my experience, however, autistic children in schools are being given their favourite toys or food as a distraction tactic to keep them occupied. This is just down to a lack of resources and training, but it disrupts any ABA therapy the child has already received. This isn’t the school's fault; the funding simply isn’t there for ABA in schools. When that funding does exist, it’s usually been fought for directly by a child’s parents - which is no easy task.
The sector is unsupported, undeveloped and, for the most part, totally under the radar. It was enough to just have a DBS check and a self-employment number to get my first job with a family. I had no real clue what I was doing and was trying to get to grips with quite a technical programme which also integrated occupational therapist and speech and language techniques. I had no comprehension of boundaries or health and safety. I ended up doing bits of cleaning and babysitting for the family as part of the job because I needed the money.
I have since worked with over 15 families, attended training courses, and become a qualified psychotherapist. I transfer a lot of my ethical concepts from a well-established registered field. I am committed to providing professional and compassionate care, but I also know that working with these children can be both trying and tiring. There is no one to turn to if a child lashes out and bites you, or brings a 2-foot plastic aeroplane down over your head (personal experience).
Without proper funding and regulation, it’s easy for individuals claiming to be ABA therapists to go rogue. Poorly trained staff attempting a complex type of therapy is a recipe for disaster, and it makes it difficult to set-up and implement a consistent ABA programme for the child.
However, if there were proper training for ABA, like there is with nurses, therapists, teachers, and if the field had the respect and funding it deserves, this would help remove significant potential for harm and mean that families were getting the support they desperately need.
There would be ethical boundaries set, contracts written and a clear expectation of support from schools. This would also protect the therapists themselves, who are often self-employed and therefore don’t receive sick pay, annual leave, or secure contracts.
Parents who have seen the progress their child makes with ABA are desperate for good, reliable tutors. It’s time to at least attempt to put some money into researching this type of therapy properly and prove that it is worth a space in society.
Autistic children deserve not only an education, but the best possible education, that doesn't cost their parents' home or mental health. ABA should be available to all who need it, not just those who can afford it.
ABA works.
Title image by Erin Cutler.
For more information about ABA therapy, and for support with autistic children visit:
Beck is an ABA tutor and a trained counsellor. She has a research interest in therapy for neurodiverse clients, and will soon begin writing a masters thesis on this topic.
