Friday, November 07, 2008

ABA success stories

Gender disturbed children desperately need treatment.
This quote is from Rekers, Bentler, Rosen & Lovaas (1977). It concludes one of multiple peer-reviewed articles authored by prominent researchers, defending a highly successful early intensive ABA-based treatment (see also Rekers, 1977; Rosen, Rekers & Bentler, 1978; Rekers, Rosen, Lovaas & Bentler, 1978). This treatment was part of the UCLA Feminine Boy Project, which for some time ran concurrently with the UCLA Young Autism Project. Its unprecendented success in treating what was considered to be an intractable pathology was reported by NIH-funded UCLA researchers in peer-reviewed journals (Rekers & Lovaas, 1974; Rekers, Lovaas & Low, 1974). One of the stated purposes of this treatment was to "cure" or "prevent" homosexuality.

The UCLA researchers repeatedly wrote that the young boys targeted by their early intensive ABA-based treatment suffered terribly and were in pain. At all possible levels (physical, emotional, economic, social, etc.), their prognosis was described as "extremely poor" with a high risk of criminal, anti-social and self-destructive behaviour. Their future was one of "numerous crippling difficulties" and "pain, misery and despair" (all quotes from Rekers et al., 1977).

Then there were the parents of these reportedly severely disordered children, parents whose needs, values and goals were considered paramount. Therefore, according to the UCLA researchers, there was a "moral and ethical obligation" to intervene and provide a treatment which had been demonstrated to be effective. The fundamental purpose of this behavior analytic treatment was, they wrote,
to help children whose present and future is so filled with hardship that it would be clearly unethical not to render them professional help. (Rekers et al., 1977)
One of the desperate children who was successfully treated, starting at age 4 (his treatment is described in Rekers & Lovaas, 1974), and who therefore became "indistinguishable" from boys judged to be normal and healthy, was interviewed at length when he was 17 and 18. Here are some excerpts from these interviews (in which he is called "Kyle"), conducted by Richard Green ("RG") and published in Dr Green's book (Green, 1987):
RG: The kind of feeling you had tonight with this guy who was looking at you and made you feel uncomfortable--what other times has that happened to you?

Kyle: I suppose I've been overly sensitive when guys look at me or something ever since I can remember, you know, after my mom told me why I have to go to UCLA because they were afraid I would turn into a homosexual.
.....

RG: I'm sure you're aware that there's a lot of social controversy about homosexuality and whether homosexuals should be allowed to be schoolteachers, should hold public office, have equal opportunity for jobs, housing, the whole civil rights question. How to you feel about that issue?

Kyle: I don't think they should because--well, I believe in God and everything and I think it's a pretty bad thing, and I think that they should try to be helped by whatever, but I think it is pretty bad, and I don't think they should be around to influence children, 'cause children are pretty easy to influence, little kids.

RG: Are you saying that homosexuality is sinful?

Kyle: I suppose it is. I don't think they should be hurt by society or anything like--especially in New York. You have them that are into leather and stuff like that. I mean, I think that is really sick, and I think maybe they should be put away.
.....
RG: When did you first have a crush on another male?

Kyle: Probably when I was in seventh grade.

RG: What do you remember about the first crush?

Kyle: I didn't like what was happening.

RG: Did it scare you?

Kyle: It did.

RG: Did it surprise you?

Kyle: Not really.

RG: Why not?

Kyle: Because I had been through all the UCLA stuff and all that. So I knew.

RG: Why should the UCLA stuff--?

Kyle: Well, because that was the reason for me to go, so I wouldn't be gay.
.....

(about his first homosexual encounter at age 18)
Kyle: It wasn't like I was real. And afterwards, a few weeks later, I tried to kill myself.

RG: Tell me about that.

Kyle: I swallowed about fifty aspirins.

RG: Did you really want to die?

Kyle: I think I really wanted to, but I knew I wasn't going to. But I really did want to.

RG: Why?

Kyle: Because I don't want to grow up to be gay.

RG: How strong an influence on your thinking is religious feeling?

Kyle: Not really strong, I don't think. It's pretty strong, but it's more me. I don't want to be that way. But religion is pretty strong too. Because I know it's wrong.

RG: Do you feel it's sinful?

Kyle: Yes.

RG: I'm not sure if I understand whether it's the idea of being gay or the idea that gay people don't live happy lives that's even more--

Kyle: I think it's both.

RG: It's both.

Kyle: Even if I was gay, I might feel happy and everything, but I know, I would know that it is wrong. I know it would be.
Kyle also states that he would have become a "total basket case" if he had not undergone treatment at UCLA. Asked what he would do if one day he was a father and had four year old boy with feminine behaviours, Kyle stated that he would take this child to a place like UCLA for treatment.

In the same book, Kyle's mother was interviewed and expressed how thankful she was for the early intensive ABA-based treatment which changed her son's behaviour.

The other young boy, Carl, whose successful ABA-based treatment was reported in the literature, also commented favourably (at age 12) on the treatment he received and its results. From Rekers, Lovaas, and Low (1974):

After our behavioral treatment, the two independent psychologists could find no evidence of feminine behavior or identification in Carl's test responses or interview behavior. Not only have family and friends remarked on the change in Carl, but he himself volunteered that he "used to be a queer, but not anymore." The treatment has clearly changed Carl's overt gender-related behaviors, suggesting that his sex-role development may have become normalized.
This was in an era where "queer" was an unambiguously pejorative word. Carl's parents were also reported to be satisfied; his mother was "pleased."

So by all reports, this early intensive ABA-based treatment was a great success for everyone involved. Everyone was reported to be happy about it--the parents who wanted treatment for their children, the boys who underwent treatment, and the behaviour analysts who provided the treatment.

And here again are the original UCLA researchers and their powerful defence of their successful ABA-based treatment:
For example, it has been suggested that the only appropriate goal of the psychotherapist dealing with a homosexual individual is to help him adjust to his homosexual orientation and behavior. Some critics go so far as to suggest that a referral to a "Gay Counseling Center" is even more appropriate, with the goal of placing the individual in contact with others like himself. We find this line of argument to be totally unacceptable and irresponsible. (Rekers et al., 1977)
And:
The non-neutrality of "gay counseling" imposes further limitations on the individual's growth potential, and unnecessarily sanctions a debilitating pattern of personal adjustment. (Rekers et al., 1977)
That is, any action in any direction suggesting acceptance of homosexuality was deemed harmful and unethical.

The world would be quite different now, would be comprehensively narrowed and impoverished, if an equivalent to current-day autism advocacy had prevailed, if this reportedly successful ABA-based treatment had not been derailed by serious criticism, including from the legendary behaviour analyst Donald M. Baer (Nordyke et al., 1977). In some of the most important, and most forgotten, writing in the behaviour analytic literature, Dr Baer and his colleagues made this statement:

The final reason for treatment was that the boy's parents were concerned. If a therapist takes only this point into consideration, then the therapist has become the parents' agent, rather than the child's, or society's. Can the therapist justify that short-sighted a role? What are the consequences for the field, and for society, if that were to become common practice? It is difficult for a therapist to be fully aware of all the issues involved when changing behaviors defined not by the person whose behavior is in question, but by other agents, such as parents or courts. This is especially true when treatment is not done by request of the person being treated. In such situations, it may be important and prudent for the therapist to seek out other people who may be more aware of the various issues involved. [...] [I]f therapists are to gain confidence in the ethics of their treatment, they should guard against treatment that unsophisticatedly threatens diversity in society. (from Nordyke et al., 1977)

[For more information about the UCLA Feminine Boy Project, see this article about ABA-based autism interventions. Ivar Lovaas' work with feminine boys was also mentioned in my Auton written argument.]


References:

Green, R. (1987). The "Sissy Boy Syndrome" and the development of homosexuality. New Haven: Yale University Press.

Nordyke, N.S., Baer, D.M., Etzel, B.C., & LeBlanc, J.M. (1977). Implications of the stereotyping and modification of sex role. Journal of Applied Behavior Analysis, 10, 553-57.

Rekers, G.A. (1977). Atypical gender development and psychosocial adjustment. Journal of Applied Behavior Analysis, 10, 559-71.

Rekers, G.A., Bentler, P.M., Rosen, A.C., & Lovaas, O.I. (1977). Child gender disturbances: A clinical rationale for intervention. Psychotherapy: Theory, Research and Practice, 14, 2-11.

Rekers, G.A., & Lovaas, O.I. (1974). Behavioral treatment of deviant sex-role behaviors in a male child. Journal of Applied Behavior Analysis, 7, 173-90.

Rekers, G.A., Lovaas, O.I., & Low, B. (1974). The behavioral treatment of a "transsexual" preadolescent boy. Journal of Abnormal Child Psychology, 2, 99-116.

Rekers, G.A., Rosen, A.C., Lovaas, O.I., & Bentler, P.M. (1978). Sex-role stereotypy and professional intervention for childhood gender disturbance. Professional Psychology, 9, 127-136.

Rosen, A.C., Rekers, G.A., & Bentler, P.M. (1978). Ethical issues in the treatment of children. Journal of Social Issues, 34, 122-36.

12 comments:

farmwifetwo said...

When I mention how horrible ABA/IBI was with my son and describe the hours of sitting at a table, the unending repetitions - sorting, matching, drawing lines - and given a toy when it's correct and 30sec or less having it taken away... People say to me "but that's not what ABA is. You must have had poor therapists."

Yes, I had crappy therapists. But I had ABA, that's what ABA is and anything else is a combination of a variety of therapy methods labelled ABA so the program gets gov't funding. Period.

I'm not convinced any unending therapy method is appropriate for a child with Autism. I find an extra 30min or homework/night (if nothing has come home), taking part in extra-curricular activities - Karate, gymnastics, piano, Cubs - to do more to help educate and teaching independance, for the boys than that 5 to 6hrs, sitting at a table, per day ever did.

S.

Suzanne said...

"It is difficult for a therapist to be fully aware of all the issues involved when changing behaviors defined not by the person whose behavior is in question, but by other agents, such as parents or courts."
amen to that.
So, if the feminine boy project has fallen away since 1977, we can expect behavior analysts to let go of autistics by, say 2039. (just my conjecture people, so don't try and pick it apart scientifically or anything!)

Maddy said...

Quite extraordinary.
Thank you.

Anonymous said...

I get really upset every time I hear about Lovaas FBP and UCLA involvement. What evaluations were done to make sure the study subjects didn't have conditions like Klinefelter's? Which may exert some behavioral changes through hormonal influence.

(Other than the fact that discrimination against sexual orientation is now illegal in USA. Can you say Bigot Dr L?)

Thanks for the citations, I probably need to go read and try to answer my own question.

Patrick

Socrates said...

It seems quite extraordinary that these people could take such a one dimensional view of homosexuality:

homosexuality=effeminacy.

Anonymous said...

Well, it appears that Rekers was aware enough to do the Karyotyping. So it kind of boils down to a power and control issue, that they, whether behaviorists, parents, or governments, allowed this to happen, because they couldn't (or wouldn't) tolerate difference.

Patrick

(A Rekers page: http://www.leaderu.com/jhs/rekers.html )

Chaoticidealism said...

Graduates of abusive "programs" of all types (not just ABA) seem to make similar statements to, "Without this program, I would be dead/crazy/etc." Many of these programs have been shut down thanks to abuse... It seems to me that in many cases the program itself drills a sort of worshipful attitude towards the program into the people who go through it. I have seen this phenomenon--a clearly abusive program seen as "the thing that saved me"--in such diverse settings as cults, juvenile reform schools, and residential programs for mental illness. The people who recovered the best seemed to have been the ones who faced up to the idea that the program was abusive... I wonder if there is something about the human mind that forces us to try to believe that what happened was somehow "good", despite all evidence to the contrary.

geosaru said...

That was so sad reading that interview excerpt. I myself am both gay and autistic, and the parallels sometimes.

Michelle Dawson said...

Geosaru wrote, "That was so sad reading that interview excerpt"

For anyone who is interested, I recommend reading the full interviews with "Kyle" and with his parents, in Richard Green's book.

storkdok said...

I never knew there was a study like this one that had been done. The parallels between the effeminate boys and autistics are extraordinary. I know this study could never be done with the effeminate boys today, but this still continues for many autistics today.

How sad. Has there been any follow up in the literature on Kyle in the last 10 years? Has he been able to accept himself for who he is?

This reminds me of the experiments by a psychiatrist in trying to feminize a young boy (I think in the 1970's) who had had an accidental genital mutilation after birth with a circumcision. He convinced the parents that he could successfully turn the baby boy into a girl. He had sexual reassignment surgery and years of "therapy", which failed, and as an adult he reverted to his birth sex and eventually had surgery and therapy to help him adjust to what had been done to him. Just horrible. To this day, the psychiatrist claims he was successful.

Michelle Dawson said...

In response to Storkdok, the boy who was experimented on was David Reimer, who killed himself in 2004 at the age of 38.

The psychologist who claimed to have successfully treated David Reimer was John Money. It was only through the great courage of David Reimer that John Money's claims were revealed to be false.

For anyone interested in David Reimer's life, I highly recommend John Colapinto's excellent 2001 book, "As Nature Made Him."

Zoe Brain said...

A few things - no, discrimination based on sexual orientation is not illegal in the USA. Efforts to make it so have failed over 34 years.

Dr Zucker at CAMH uses aversive therapy techniques to de-feminise boys, and de-masculinise girls. He tries to turn them into gays rather than transsexuals.

So don't expect the begaviour analysts to "let go" of autistic kids any time soon.
There are certain sequelae - in one case, a boy so treated now has anxiety attacks when he sees the colour pink. Many of the "successes" have suicidal ideation.