Friday, November 17, 2006

Not the last word on aversives

There won't be a last word on aversives...

... until autism advocates (including politicians, parents, and professionals), in Canada and elsewhere, stop promoting Lovaas (1987) and its follow-up (McEachin et al., 1993) as evidence that ABA-based interventions are "effective".

In reality, this famous study is evidence that an early intensive behaviour intervention wasn't effective at all, for even a minority of autistics--not without the unacceptable systematic use of physical punishment. Lovaas and colleagues instead provide guidance in how to spot ineffective (meaning, e.g., grossly inadequate, and possibly harmful) interventions or programs. These would be interventions or programs accompanied by claims or evidence that unless autistics are deliberately and systematically hurt, we will fail to learn and/or are doomed. Would our influential autism advocates call a preschool program for non-autistics "effective" if the kids only made meaningful progress when they were hit? And if our eminent autism advocates wouldn't, why are they insisting that autistics deserve such lousy standards?

... until autism advocates stop using the Auton trial decision, the New York State Dept. of Health report, and the US Surgeon General's report as "proof" that ABA-based interventions are "effective".

All these popular lobbying tools are heavily dependent on Lovaas (1987) and McEachin et al. (1993). Using them sends the same message as the invariable flourishing of the famous 47%: that it's acceptable to use aversives on autistic children when ABA-based interventions do not otherwise work. This is the current-day rationale for existing aversive interventions, including those provided at the JRC.

... until autism advocates stop claiming that ABA-based interventions are "effective" for all autistics, and that all autistics are doomed without ABA.

This follows from the previous point. According to the published data, and by their own standards, ABA programs fail more often than not; in the current climate, autistics who do poorly in ABA programs are likely to stay in them indefinitely. But there are also some parents and professionals who claim that when non-aversive ABA fails, the necessary next step is the use of aversives. There's Matson (2006), who raises concerns that non-aversive ABA programs are excluding autistic children who really need aversives. Kit Weintraub's letters and the vehement support for the JRC, the routine use of risperidone or other anti-psychotics as part of some ABA programs, etc., are examples of how uncritical cheerleading of ABA programs can be seriously hazardous for autistics who do poorly in ABA.

... until autism advocates stop their extraordinary campaign to deny autistics basic standards of science and ethics, and basic human rights.

This campaign (here's a popular example; links to another popular example, Canada's autism community flagship website, can be found within my response to it) being, with occasional digressions, the subject of this blog ... So long as autistics are feared, dreaded, unwanted, dehumanized, reduced to drains on society, written off, and have our voices denied, there will always be those who can, with impunity, claim that we really need to be hurt, or we are doomed. So long as it is so vigorously argued that there is nothing worse than being autistic, then it will remain acceptable to treat us in ways that would never be acceptable for other human beings.

... until aversives are illegal, everywhere.


References:

Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Matson, J.L. (in press). Determining treatment outcome in early intervention programs for autism spectrum disorders: A critical analysis of measurement issues in learning based interventions. Research in Developmental Disabilities.

McEachin, J.J., Smith, T., & Lovaas, O.I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97, 359-72.

3 comments:

laurentius rex said...

Michelle if you can leave aside your personal crusade against ABA for a moment and realise I am no more enamoured of it than you are, I would like to know what you think of interventions for other disabilities such as conductive education which involved the same fanaticism from parents when it first came out over here in the UK.

It was a case of parents forcing a normalising dialogue upon there children to the extent of campaigning for the procedure to be routinely paid for as a vital intervention by the various authorities and if not that the raising of vast sums of money to send there children to a foreign country and a foreign culture to recieve such dubious treatment in Hungary.

Now did that ever happen to any autistic? well yes it did if you happened to be both autistic and CP.

Neither should we be so isolated as to forget the continuing abuses of ECT.

Let's forget our differences over the meaning and construction of science and agree that it is not just the behaviourists who have sinned and that they are part of a wider culture of abuse in the name of a normalising culture where difference is something to be eradicated at any cost.

And I have not even started on psychotropic medication yet.

Michelle Dawson said...

Hi Mr Rex,

I don't have a "personal crusade" against ABA-based autism interventions. Criticizing science--which is meant to be criticized--and raising questions about basic ethical standards isn't the same as mounting a crusade. It's what scientists are supposed to do.

Some other day I'll write about the implications of how criticisms of ABA-based interventions have been responded to.

Also, since it's on the record that I've been a much stronger and more effective (and definitely much harsher) critic of cognitive science and neuroscience in autism than I have been of ABA in autism, I'm as usual incapable of understanding what you're getting at.

abfh said...

Larry, in economics they talk about how specialization improves productivity. It's the same in blogging. If a person has a lot of knowledge about one or two issues, it's often better to write mainly about those issues and to give the readers the benefit of that expertise, rather than to try to write equally on a wide variety of topics and do a mediocre job on most of them.

This isn't meant as a criticism of your blog, but as a general observation. :)