Are We Treating Autism Properly?

The evidence supporting applied behavior analysis is flimsy at best

I have a new piece out in City Journal that looks at the recent controversy surrounding Applied Behavioral Analysis (ABA), one of the most common autism treatments. Proponents of ABA have argued that it is evidence-based and improves autistic children’s functioning. Critics say the treatment constitutes a form of abuse and is not backed by solid science. I make the argument that we don’t really know, because it hasn’t been studied well.

Few studies evaluate autistic children’s negative experiences of [ABA], making it hard to conduct an adequate cost-benefit analysis. Those studies that report children making long-term gains in functioning are of middling scientific quality, casting doubt on the therapy’s status as an authoritative treatment. Practitioners and parents swear by the therapy, while many of those who receive it don’t support its use. It’s plausible that ABA is helpful in some cases and harmful in others, but without a commitment to the scientific process and rigorous policy evaluation, we will never be sure whether, and for whom, the therapy works.

One autism researcher came to a similar conclusion as me while writing a report on the evidence for autism treatments, and was harassed by members of the autism care community.

Soon after Whitehouse released his report, numerous clinicians, therapy providers, and professional organizations went after him. They complained to his employer about his research, threatened to sue him, and harassed his family members. Their desire to attack a scientist who exposed the shabbiness of this literature—rather than the generations of scientists who compiled a low-quality body of work—speaks to how little the field today is focused on successfully understanding autism. A whole credentialing apparatus—professional organizations, certification bodies, and college-degree programs—revolves around ABA. As long as parents and the public believe the therapy is scientific, the ABA apparatus can keep profiting.

This looks like a typical case of trying to cancel someone whose research offends you, but in this case the topic of the research is literally whether the treatment we are using on some of society’s most vulnerable people is effective or not. Shouldn’t everyone want to know the truth?

Read the full article here.