The American Medical Association has received a proposal for the removal of AMA Support for Applied Behavior Analysis (ABA). This is very exciting news.
ABA has been pushed as the “gold standard” of treatment for Autism in children for decades, despite overwhelming anecdotal and objective evidence demonstrating the numerous risks and harms of coercive behavioural interventions.
It’s wonderful to see up and coming physicians speak up on this very important issue which has been ignored for way too long.
The full AMA House of Delegates Handbook is over 1500 pages long, so I won’t be able to summarize its contents in an article, but I will highlight the salient arguments brought forth by the Medical Student Section of the AMA (yay med students!).
AMA’s June 2023 Annual Meeting
The American Medical Association (AMA)
The full resolution proposal is outlined in the AMA House of Delegates Handbook (pp 1187–1189). I will provide a summary of the most relevant points, but have cited the full document for those who wish to read further.
ABA was conceived in 1961 by Dr. Ole Ivar Lovaas to condition neurotypical behaviors in children he viewed as “incomplete humans”
Desired behavior is often defined by the adult or behaviorist without input or requirement of consent from the child and may include non-harmful stimming or coping behaviors
ABA uses behavior modification techniques to eliminate behaviors deemed undesirable
ABA practices are historically based in abuse such as holding autistic children’s communication hostage through the use of their devices as leverage, and denying basic rights such as food and toileting privileges
Modern ABA still abides by the founding principle of making a child appear “normal” or “indistinguishable from one’s peers”, which serves to separate the humanity of the individual with autism from desired behaviors [emphasis added]
A 2018 study found that Adults with autism who have received ABA are more prone to suicide
ABA has been repeatedly linked to Post Traumatic Stress Disorder (PTSD), with 46% of 460 ABA participants meeting the diagnostic threshold for PTSD in an online survey
Adults with autism have been continuously outspoken about the trauma incurred by ABA practices experienced in their childhood
A 2012 literature review found the evidence base for services for adults with an ASD to be underdeveloped
A 2018 Cochrane review recommend further research after reporting very weak evidence in support of ABA
An informal online community survey found that 71% of adults with autism responded “disagree” or “strongly disagree” to the statement “Generally speaking, I support ABA therapy for autistic children” [emphasis added]
A 2020 Department of Defense report demonstrated a lack of correlation between improvement in symptoms and hours of direct ABA services
A 2021 study on conflicts of interest (COIs) in autism early intervention research found COIs to be prevalent and under-reported, with 70% of studies containing a conflict of interest and less than 6% declaring them as such
Current research supports alternatives to ABA such as the Developmental, Individual Differences, and Relationship-based (DIRTM) program, the PLAY Project, individualized Early Social Interaction (ESI) and, Social Communication, Emotional Regulation, and Transactional Support (SCERTSTM)
Concluding statement and proposal
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