I am responding to the opinion article written by Isabella Rosario (“UI autistic therapy startup promotes harmful treatment” Oct.20). I very much welcome ongoing discussions about autism, its diagnosis, and treatment options; however, I found the article to contain a number of inaccuracies that may be hurtful to the families who have chosen Applied Behavior Analysis (ABA) as a treatment for their children. As co-director of the University of Iowa Children’s Hospital Autism Center, I would have been very pleased to have discussed Rosario’s concerns about ABA with her and to have put her in contact with families using ABA and other treatment approaches, but this did not occur. Thus, I feel very strongly that a response to this opinion article is required in order to provide more accurate information about ABA.
Autism is a neurodevelopmental disorder that affects approximately 1 in 68 children in the United States. Autism is characterized by substantial difficulties in the areas of socialization and communication as well as the presence of repetitive behaviors and restricted interests that can interfere with daily functioning. Upon learning of an autism diagnosis, parents are understandably interested in treatments that can maximize their child’s potential to lead a meaningful, happy, and independent life.
An impressive amount of research has been conducted over the past five decades on treatments for autism. Based on this research, a strong scientific consensus has emerged regarding the effectiveness of ABA. It is widely recognized in the scientific community as a safe and beneficial approach that is based upon well-established principles of learning. The purpose of ABA is to use evidence-based techniques to promote skills that lead to opportunities for successful living in community settings — a goal that is highly individualized and guided by input from parents and, to the extent possible, from the child or adult with autism. Hundreds of independent studies have demonstrated that ABA techniques can lead to improvements in communication, play skills, social relationships, academic performance, and necessary work and independent living skills.
Rosario makes several assertions that are either inaccurate or highly misleading. Specifically, she states that the purpose of ABA is to make children “indistinguishable from their peers” (ABA therapists are very invested in decreasing behaviors that can cause long-term harm such as self-injurious behavior along with behaviors that clearly impede meaningful participation in daily life); that ABA does not focus on improving speech or nonverbal communication (numerous ABA studies have focused on improving communication); that therapists frequently utilize punishment (this is a historical comment that is no longer the case); that ABA makes individuals more susceptible to abuse or coercion (I am unaware of any studies that have shown this to be the case); and that ABA therapists are not interested in commonly co-occurring conditions such as anxiety and sensory sensitivities (these related symptoms are often treated by other disciplines that compose the Autism Center, including psychiatry and occupational therapy, though ABA is also often included in a comprehensive treatment plan that addresses these concerns).
I respect the right of anyone to express their opinions and strongly encourage care providers to make informed treatment decisions. With regard to Rosario’s criticism of ABA, I believe that the feelings and rights of families with children with autism should also be considered. Many of the assertions by Rosario suggest that caregivers who have chosen to use ABA have made a poor decision for their children, and as such, the article is very critical of them. Similar to the advice that I provide to families, I suggest that Rosario carefully study existing evidence-based options that are available in the treatment of autism. A good place to start would be to contact the Autism Center at our university to learn more about the state of current research and research-supported treatment options.
— Todd Kopelman