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Last fall, when Xavier DeGroat received an opportunity to work at the White House as an intern in the Office of Presidential Correspondence, he packed his bags at his home in Lansing, Michigan, and relocated for three months to the thriving metropolis and national capitol of Washington, D.C. Only Washington, D.C., wasn’t the usual hub-bub of activity. Under lockdown due to COVID-19, an eerie quiet fell over the city—a quiet, intermixed with the frenetic anxiety of the 59^th presidential election and the departure of then-President Trump.

Still, Xavier welcomed the chance to serve his country and work in the White House. Recently, LEARN talked to Xavier about his experience in Washington, his work for the autism community, and his thoughts, as an adult with autism, about some of the community’s most pressing issues.

Q: Tell us, Xavier, about your experience as a White House intern.

A: From September to December in 2020, I lived in D.C. It was a wonderful experience that gave me a lot of networking opportunities, which is great for my advocacy work with my foundation, the Xavier DeGroat Autism Foundation. Of course, it was a turbulent time, with the presidential election and COVID. Security was a major issue, but I had a job to do. In the Presidential Correspondence Office, I checked the mail and the endless letters coming to the president—there were letters about issues relating to stimulus checks, letters of sympathy for the death of Robert Trump, the president’s brother, and a mix of critical and supportive letters for the president, too.

I had met President Trump the previous year, in the Oval Office, when I had a chance to speak with him about matters related to the Department of Homeland Security and the police force. You see, sensory overload anxiety can be triggered easily in people with autism at airport checkpoints, which are full of crowds, noises, and bright, flashing lights. So, I was there to talk about the TSA regulations that need changing, in addition to regulations about restraining people with autism and disabilities. The meeting was supposed to be only five minutes long, but I was there for a full half hour. “Do you mind if I call you X man?” President Trump asked me. He was really friendly and personable.

Q: That sounds like an amazing experience. Now that you’re back in Michigan, what are you working on now with your foundation?

Right now, I’m devoting time to fundraising. I’ve realized over the years that without money, we can’t do much. I also have some events coming up next spring in Ann Arbor, Michigan. I’m a big sports fan and love the idea of sensory rooms at stadiums. Jim Harbaugh, head coach of the University of Michigan’s football team, will be part of the initiative, along with his brother John Harbaugh, head coach of the Baltimore Ravens.

Soon, I’m going to the Oval Office to speak with Joe Biden and Kamala Harris about health insurance, and how hard it is for people with autism who can’t work to afford insurance.

I’m also publishing a book about my experiences.

Q: What, specifically, is your book about?

A: It’s a memoir about my life. I have a long story full of challenges that I eventually overcame—I hope I can inspire other people. I was diagnosed with autism at age 4, though originally told I had ADHD and given Ritalin. Later, they realized I had some sensitivities and anxiety and told my parents I have Asperger’s syndrome. I also had epilepsy, which was more concerning than autism for my family because of the health risk.

In school as a kid, I was labeled with “the R word” and had a hard time understanding or using sarcasm, nuance, and what I call “gray language skills.” I took things literally, like many people with autism. This would lead me to use the wrong word, miscommunicate, or struggle to conceptualize conversations. Ultimately, it led me to get bullied at school.

I spent a lot of time during my childhood at home and alone. I didn’t get the resources I needed, and school was overstimulating. I wanted an in-between, where I could have family around to support me and activities to keep my mind and body in shape. Things like LEGOS and puzzles calmed me.

High school was the most challenging time. I dropped out of school in 11^th grade for about three months when the bullying became especially bad. Kids were immature or disrespectful. I couldn’t cope, and even some of my teachers didn’t understand me. They tried to give me accommodations, like extra time on assignments, but my problem was really with the whole environment. My dad helped me find a summer school program, which allowed me to catch up and still earn my diploma the next year.

Around that time, when I turned 17, the doctors did some tests and realized I didn’t have epilepsy anymore. This was truly enriching. I was able to get my driver’s license and start driving a few years later, after everyone knew it was safe. I could go anywhere I wanted, on my own timeframe. That was a real turning point.

Now, I’m doing some groundbreaking things and devoting my life to helping people with autism.

Q: That’s an inspirational story that many people, autistic or not, would love to read. What are some things you wish people understood about living with autism?

A: Children with autism need to be themselves. They need time to touch things or even rip things and make a mess. They’re not staring off into space or exploring aimlessly or because they’re just wanderers—they’re doing it because they’re curious and trying to make sense of the world and figure things out. They need space to think and ask questions, and some schools just aren’t the right environment for that because they focus too much on being on time and doing everything within a certain time period.

I think neurotypical people can learn a lot from neurodiverse people if they take the time. In fact, I don’t like to think of autism as a disability because it’s really about neurodiversity. If you look at an autistic’s neurodiversity, you might see that certain skills can be even more accelerated than a person without autism.

I would also advise people not to get anxious when an autistic is quiet. Some are introverts. They keep to themselves, and that’s OK.

Q: After listening to some of the conversations about Autism Awareness versus Autism Acceptance Month, our organization, LEARN, decided to embrace acceptance, without losing sight of awareness. Do you have any thoughts on that conversation?

A: I like the change to acceptance, as long as we realize that without awareness, there can be no acceptance. It’s takes about 99 percent awareness to have one percent of acceptance. It all starts with education. We can’t force people to accept something they don’t understand. As the late Congressman John Lewis once told me, everybody is aware that I’m Black, but that doesn’t mean they accept me. So, yes, acceptance is the greater goal.

Unlike some autism activists, I don’t get too hung up on language. It’s more about how the person treats me than whether they call me “autistic” or a “person with autism.” Some people might prefer one to another, sort of like some people preferring “Black” to “African American.” It really just depends.

Q: You’ve created an impressive platform for your advocacy work. Who inspired you along the way?

A: My parents inspired me. I know I cost them a lot of money growing up, and sometimes I feel ashamed of that. But they also said to me: “We want you to be successful. We want you to be independent.” They set those goals for me, and that helped.

I don’t have a bachelor’s degree yet, but I’m looking at finishing college. I want to earn a degree, but I think I’ve had great life experiences that add up to more than a degree, probably. Nikola Tesla didn’t go to college but became who he is today through hard work and effort. He definitely inspires me.

Temple Grandin, the scientist and activist, also inspires me. She’s a friend of mine and has told me: “You have a mission to do something specific with your life, and you’re doing it. You’ve pulled yourself up and earned it.” She’s all-generational in her advocacy and believes that it’s not so much words that matter. It’s how you use them. That’s why I have a problem with some of today’s activities—they sometimes go a little too far. I consider myself more middle of the line.

As a child, I wanted to be an astronomer. Later, when I met Stephen Hawking, he encouraged me to get out there and explore, which is what scientists do. He said I didn’t have to be a paid scientist at NASA to think and act like a scientist—I could be an amateur scientist and use that mindset in my life. He said that when people with autism ask questions—How big is the sky? How big is the universe?—maybe they’re interested in learning things. They’re not being annoying. They actually want to figure things out.

Our new series, “Spotlight on Black Professionals in ABA,” continues with an interview with Maia Jackson, the clinical development manager of LEARN Behavioral’s Autism Spectrum Therapies (AST) office in Oakland, California, in the East Bay region of the San Francisco Bay Area.

The series comes on the heels of an analysis conducted by the Behavior Analyst Certification Board (BACB), which found that Black behavior analysts make up only 3.6 percent of the total board certified behavior analysts, a number that lags behind the 13.4 percent of Black people living in the United States, according to 2019 U.S. Census data.

Here, Maia talks about her experience and the critical need for mentorship in the ABA field.

Q: Thanks, Maia, for taking time to chat with us. Let’s start with the beginning: how did you get into ABA? What attracted you to the field?

A: My senior year in college at Sacramento State University, I still didn’t know what I was going to do. I majored in psychology, which is kind of general. As I got closer to graduating, I went on Craigslist—that’s a sign of my age—and saw a job posting that said, “Work with kids!” I really enjoyed kids and thought, Why not? I ended up taking the job and doing direct intervention with four- and five-year-old kids with autism spectrum disorder (ASD). They were adorable.

After a few months of that, I knew I wanted to continue but in a way that allowed me to grow in the field. I started Googling and looking at various options for graduate school, ultimately enrolling in National University’s master’s program in education, which offered a specialization in ABA.

Q: What was graduate school like for you?

A: It was an interesting, though busy, experience. I kept my job with Bridges, an ABA provider in Sacramento, and juggled work with studying. It helped that most of my courses were online, but that also made it harder to make connections and interact with my peers and professors. My studies lasted about a year and a half, and when I graduated, in 2009, I needed a board certified behavior analyst (BCBA) to observe and supervise me in the clinic for a set number of hours, in order to earn my own credentials as a BCBA. But ABA was still a relatively new field, at least in regard to autism, and I couldn’t find anyone to supervise me. There just weren’t that many BCBAs around at that time.

In 2011, I ended up taking a job with AST, which had recently opened a new office in the Bay area. The office caseload grew quickly, which was exciting but also challenging—I was thrown into the mix. There was a learning curve, but I got the supervision and support I needed to earn my BCBA certification and ultimately help kids and succeed in the position.

Q: What was the supervisory experience like for you? What kind of feedback did you receive on your work in the clinic?  

Someone from one of AST’s more established offices in southern California drove up to supervise me, and that was a real game-changer. I came to think of her as my mentor. In fact, I didn’t know what I had been missing until I had someone come in and provide that level of support. Mostly, what she gave me was time—time to sit and listen as I talked about my cases, time to answer my questions, time to trouble shoot. I hadn’t had that level of support before. She gave me her input and clinical guidance and expertise. Plus, she was a woman of color, like me, and I hadn’t worked with a woman of color in ABA until that time, even in grad school. She gave me the confidence to express my thoughts and concerns about the job, and advice on how to balance my professional and personal lives. We still keep in touch and call each other to troubleshoot or even just catch up.

Q: It sounds like the relationship with your mentor was a game changer, indeed. How has that experience influenced your continued work in behavior analysis?

A: Well, right now I work as the clinical development manager, supporting newly hired trainers and providing training to new supervisors, so my job, essentially, is to help guide and support new employees in clinical positions. This is important because the better trained we are, and the more we feel supported in our positions, the better the outcomes for our clients and the higher retention rates for our team.

I’m also part of a team of five professionals at LEARN launching a mentorship program for employees taking part in our organization’s Future Leaders Diversity Advancement Program Cohort, designed to increase the number of Black BCBAs at LEARN. The program provides financial assistance to employees attending National University’s master’s program in ABA. As I mentor, much of what I’ll do is what my mentor did for me—listen, guide, and help troubleshoot any problems that come along, whether related to the field or to things like work-life balance.

Mentoring is something I truly love doing. It differs from a supervisory role, where people might be guarded and careful with what they say. In a strong mentor relationship, people can pick up the phone and call anytime without worrying how they’ll be perceived. The focus is on building confidence, happiness, support, and growth.

Q: In your own words, why do you think it’s important to increase the number of Black professionals in ABA—and to increase diversity across the field, in general?

A: At LEARN and AST, we have a diverse clientele, though I’d like to see an even more diverse clientele—to see a broader range of children accessing services. Systemic issues prevent some children from getting the care they need. It often starts with well-baby checks, for instance, where a pediatrician might not refer patients who are Brown or Black to the appropriate resources in a timely manner or might not diagnose them early enough. Difficulties with transportation, work schedules (with parents working multiple shifts), and funding also prevent some children from getting the care they need. Plus, not everyone can afford services. Even with insurance, a $40 to $45 co-pay several days a week adds up quickly.

Early diagnosis and intervention are also critical. Studies show that Black and Hispanic children are diagnosed later than white children. We need to do more to make sure all children are diagnosed as early as possible so they can take advantage of the benefits of early invention. Increasing diversity among BCBAs, who can go out in the community and conduct parent and caregiver workshops, while raising awareness to pediatricians and other people in the community, are key to better serving the broad range of children in need. LEARN’s partnerships and community liaison team are doing that important work, and I would love to join and support their effort going forward.

Read the first interview in this series, “Spotlight on Black Professionals in ABA: Brandon Whitfield,” and find out more about our Diversity, Equity, and Inclusion Plan.

As parents and caregivers, we’re hard-wired to respond to our children’s cries with efforts to comfort and soothe. Nothing is more frustrating, however, than when our efforts fall short—and our child spirals into a meltdown. What can help? In a few words: a calm-down kit.

A calm down kit is simply a collection of objects and items to help children cope with their emotions in a positive and safe manner. Also known as sensory integration boxes or toolkits, each calm-down kit can look a little different, depending on the needs and interests of your child. Of course, you can buy preassembled calm-down kits online, but your kit won’t have the magical ingredients that can comfort your child (aka, the objects and items your child loves), and often, these kits don’t take into account things like ages and sensory needs.

How, then, can you create your own calm-down kit to soothe your child’s sensory system during a meltdown? Here’s a breakdown of what to include—and how and when to use the kit.

What to include in your kit

As a parent or caregiver, you know your child best. Ask yourself these helpful questions:

• What soothes your child when restless?
• What usually calms your child down?
• What does your child like to do?
• What are your child‘s favorite items?

Gather together an assortment of items generated from the questions above, along with objects that cater to various senses, such as sight, sound, touch, and taste. For instance, you might include:

• A weighted or soft blanket, which can help kids who respond well to deep pressure receptors.
• Fidget toys that can occupy the mind and fingers by giving kids something on which to focus.
• Noise cancelling headphones, which can provide the peace and quiet kids need during a sensory meltdown or outburst to calm their bodies.
• Bubbles, which can help kids take deep breaths for relaxation, without realizing it.
• Chew toys to provide oral sensory support and help some children focus and manage feelings of anxiety and sensory overload.
• A stress ball to squeeze and release anger and overwhelming feelings.
• Plastic baggies full of various materials like kinetic sand, oatmeal, pasta, pine nuts, or rice, which can satisfy cravings for tactile stimulation.

How to use the calm-down kit

Once you have the items, place them in a backpack or cloth bag, and take the kit with you in your car or on the go. Then, once a sensory meltdown starts, use the items either to refocus your child’s attention and lessen the magnitude of the meltdown after it begins. Keep in mind, too, that  you can use the kit anytime, even during typical downtime. Using the calm-down kit during downtime will serve as practice and enable your child to figure out what items help in times of distress.

Again, the goal of the calm-down kit is to give kids the tools they need to transform their inner state from upset to calm. These kits can make all the difference, not only for your child but also for  you, as a parent or caregiver.

Want to learn more about sensory issues? Listen to our podcast, “How Lighting Can Affect Your Circadian Rhythm,“ on All Autism Talk.

Becky Schoenfeldt, a registered behavior technician (RBT) for LEARN’s Behavioral Concepts (BCI) clinic in Worcester, Massachusetts, spends her days helping kids with autism attain goals on their behavioral health treatment plans. At the end of the day, she goes home to do more of the same, only this time with her 18-year-old son, Dougie, who was diagnosed with autism at age three and needs round-the-clock care.

In a recent interview, Becky talked about her journey with autism, the pitfalls and triumphs along the way, and the lessons learned as both a parent and practitioner in the field. In honor of Mother’s Day, she gives advice to other moms—and all parents and caregivers of kids with autism—about the challenges and rewards.

Q: Let’s start from the beginning, Becky. You were working as a case worker for the Housing Authority, helping families from homeless shelters find work and become self-sufficient, when you noticed developmental delays in Dougie. Tell us about that time period.

A: That’s right. At the time, I spent my days—and nights—helping families get back on their feet after setbacks. I also worked for the Department of Youth Services, the juvenile justice agency in Massachusetts that serves kids and teens who were arrested or charged with an offense. The work wasn’t easy and required late shifts. When I became a parent, I knew I couldn’t keep working there because of safety issues related to the challenging behaviors of some of the kids. I had three little children close in age—technically, Irish triplets. Dougie and Stevie, my twins, have a sister Alli who is only 11 months older. I had my hands full.

Stevie and Alli are neurotypical, so I noticed certain things were different with Dougie. Instead of crawling, he would scoot on his butt. He wouldn’t respond to his name or loud noises. We would bang pots and pans and get no response. He also didn’t make eye contact or speak. But he was sweet and adorable. Once he started walking, he would take us quietly by the hand and lead us along. He was a happy boy.

Often, I brought up my concerns to family and friends, and they would say, “Don’t worry—he’ll eat [or walk or talk] when he’s ready.” The pediatrician kept saying, too, that twins do things at their own speed, that I shouldn’t worry. But I knew in my heart something wasn’t right.

Q: What was it like getting the diagnosis?

A: We were prepared and knew it was coming, but it still felt like a kick in the gut to hear those words. I worried about his future, his present—everything. And then I realized: parents of newly diagnosed kids can either wallow in self-pity or start supporting their child so he or she can live the best life possible. That’s what we did—we were proactive and started supporting Dougie.

We lived in Connecticut at the time and enrolled Dougie in preschool, thinking it would be a good opportunity. When I picked him up from school one day, they told me he had eaten rocks—as though that was normal behavior for a child. “What do you mean, he ate rocks?” I asked them. They said it wasn’t so unusual, but I didn’t believe them. I worried about his safety.

We decided to move to Massachusetts, where my mother-in-law worked as a teacher in a local school district. We had high hopes for Doug’s first school in Massachusetts but came to realize our son needed more support than the school could provide, despite their best intentions. Sometime after kindergarten, Dougie spotted a red jeep in the parking lot that looked like his grandmother’s car. Thinking it was, in fact, his grandmother’s car, he bolted out the door, somehow getting past several staff members—six of them, I was told. How could a kid bolt past six staff members? Why couldn’t they protect my son?

For a long time, Dougie has had an issue with bolting. Even today, if he sees something as ordinary as a squirrel across the street or a holiday decoration nearby, he might take off. He doesn’t have the safety skills.

Q: Did you end up keeping Dougie at that particular school? What was your relationship like with the school staff?

A: We realized the regular public school wasn’t right for him. They wouldn’t allow him to use noise cancellation headphones or other coping mechanisms, like a weighted scarf or blanket. Their attitude seemed to be: if you can’t change the environment, you change the kid. But it was more the environment that needed changing, with so many noises and the constant bells ringing and beeping, the harsh lights, smells, and crowds. These things really bother kids on the spectrum.

We tried to get Dougie placed out of the school and put into a more supportive set up, but that would have cost the school district money they didn’t want to pay. Plus, they would have had to admit that they couldn’t manage Dougie, which they didn’t want to do. So, it was an all-round bad situation.

Growing up, Dougie had severe self-injurious behaviors (SIBs) like head-banging or hitting his head. He often did this on the school bus, and the bus monitors weren’t trained to handle it. I had to leave work several times to pick up Dougie from school, especially in 6^th grade—that year was horrible. But the school principal was great, and knew we needed something different. We ended up hiring a lawyer to help us get the school district to “outplace” Dougie, meaning they paid for him to attend another school. It worked, and that was the best $350 we ever spent.

Q: That sounds like an incredibly rough year. What happened next? How did you get Dougie the help he needed?

A: Around the time, I had retrained in my career and worked as a behavior technician for BCI. It was stressful because I kept having to call out of work to take care of Dougie. I finally went to Dr. Robinson, the founder, and asked if Dougie could get a spot in a social skills group at BCI. We worked out an arrangement, and Dougie started ABA therapy.

Eventually, with the help of Dr. Robinson and the lawyer, we secured a spot for Dougie at a school for kids with autism, the Center for Applied Behavioral Instruction (CABI), in Worcester, and that has made all the difference. He has one-to-one attention, a highly-structured routine, and only six or so students in the classroom. He’s a happy kid now—a completely different kid now. He’s doing geometry. He works as a cashier in the school store. Best of all, he actually seeks interaction and even physical contact, like a hug, from people he trusts.

He also discovered he likes art. Just like his dad, Dougie is a talented artist. He loves to draw on whiteboards, and loves to draw Sonic characters.

Q: CABI seems like a great place. Have you thought about life after CABI? How long can Dougie stay there?

He can stay at CABI for four more years, until he ages out at 22. It’s gone by so fast. My husband and I both have to work, and we’re not sure what we’re going to do. We’re looking at day programs because Dougie will still need structure. But I want him to do more than bag groceries at Shaw’s. I hope he can find a job and do something related to art, something he’s passionate about, though I wonder how he can hold down a job if there’s a loud noise, like a baby crying. He would need an understanding, supportive work environment.

I worry about Dougie getting older—and me getting older. I don’t want him to end up in a residential program. For many people who work at those facilities, it’s just a babysitting job. But it’s far more than a job. It’s someone’s life you’re molding.

Q: Yes, it’s an opportunity to really influence and mold, as you say, an individual’s character—a person’s whole life, really. What has it been like for you, as a mom and an RBT?

A: Helping kids and families with autism is who I am and what I do. I’ve finally found something I enjoy, and it’s nice working with families. I never dread going to work because when I open that door, I know I’m a positive reinforcer. The other week, one of my kids fell asleep during a session, so we had to reschedule. Then I didn’t see her the next week because of Dougie’s spring break. When I finally got to see her, she gave me an enormous hug. That’s pretty rewarding.

When we had to go full remote with COVID, life was a rollercoaster. Dougie adjusted well because I set up his environment and work area similarly to school, with his visuals and sensory objects in place. We followed his treatment plan and kept making progress.

Q: What advice do you have for other moms or caregivers raising kids with autism?

A: I see a lot of single-parent families, mostly where it’s just the mother. That’s not easy, especially if there are other kids in the family she has to care for. When parents have their own personal problems they’re dealing with, that can make it difficult to support the goals of therapy at home. But that part of therapy is so critical—learning has to continue in the home environment.

The advice I can give other moms and parents is to build your support network. It might take work, but the effort is worth it. Also remember that no challenge is too big, and no victory too small. I like a challenge and decided to rise to the challenge of raising Dougie and two other kids, while helping kids in my job. It’s not easy, but it’s my life, and I wouldn’t trade it for anything.

Q: With your busy schedule, how do you practice the important art of self-care? What will you do for fun this Mother’s Day?

A: For self-care, I make every moment count, even when I’m at the grocery store. Sometimes, I just enjoy the quiet of walking down an aisle alone, getting to think or move at a slower pace for a moment. This summer, I’ll go to the zoo and water park with my family. We’ll get outdoors and do some of the things we couldn’t do last summer because of COVID.

On Mother’s Day, I’ll be with my family, but the weekend before, my daughter, Alli, will be home from college—she goes to Roger Williams University in Rhode Island. On Sunday, I’m taking the two of us to get our nails done. It’s an early Mother’s Day present before she has to go back to school.

by Ronit Molko, Ph.D., BCBA-D
Strategic Advisor, LEARN Behavioral

Applied behavior analysis (ABA) is widely considered by many professionals and families to be the “gold standard” in intervention for children on the autism spectrum. With decades of empirical evidence to support its efficacy at teaching necessary skills and reducing maladaptive behaviors, ABA is broadly funded by private and government insurance plans and typically supported as the premiere teaching tool for autism.ABA is used more extensively than many people realize. In general terms, ABA refers to the science of teaching and learning or, more specifically, the idea that, over time and through repetition, we can increase behavior that is reinforced, while decreasing behavior that is not reinforced. Corporations and marketing companies use the principles of ABA to affect buyer behavior, just as teachers use ABA to manage students in classrooms. Likewise, ABA is used to train and modify behavior in athletes, musicians, employees, and even animals.

In the autism field, the services market has evolved and expanded, leading to significant variety among ABA providers. Consequently, the term “ABA” has become associated with a broad spectrum of services, some of which do not meet the standards and definitions of true applied behavior analysis.

Additionally, there is growing criticism from self-advocates and autistic adults who received ABA services and now share stories of experiencing PTSD (post-traumatic stress disorder) and trauma from the ABA they received. Stories like these are sad and heartbreaking to hear—and call upon all of us in our field to listen to and learn from the conversations, instead of plowing onward in an obstinate disregard for lived experiences. As a profession, we need to use these conversations to reconsider how we approach intervention, and ask ourselves: are we changing specific behaviors because we determine them to be appropriate or inappropriate or because making this change actually serves the person with autism?

We also need to understand the evolution of ABA over the past 70 years. To understand the evolution, one needs to understand the history, and how we reached the point where some individuals and groups find fault in ABA. In my opinion, we cannot simply declare that old ABA was harmful and bad, while current ABA is helpful and good. If our treatment harms even a single individual, that is one individual too many.

The origins of ABA

Up through the early 1900s, the predominant theories and schools of psychology focused on thoughts and feelings. Dr. John B. Watson, a pioneering psychologist, popularized the theory of behaviorism in 1913. Watson believed that instead of focusing on internal and mental states, the practice of psychology should focus on observable behavior. Dr. B. F. Skinner further developed the theories of behaviorism to describe how we learn—essentially, by describing and researching how our behavior is changed based on antecedents (what precedes a behavior) and consequences (what follows a behavior—i.e., the rewards and punishments we receive).

The principles of teaching using ABA were further defined by multiple researchers in the 1960s, forming the basis of ABA. In the mid-1960s, Dr. Ivar Lovaas developed a program designed to teach language to children with autism, using the principles of applied behavior analysis, with the goal of preventing children from being institutionalized. Lovaas’s program included 40 hours a week of intensive and rigid clinic-based ABA, with the findings of his research demonstrating the efficacy of intensive ABA on teaching language and other skills to children with autism. As a result of this research, early intervention programs were launched, and ABA became more popularized as the best form of intervention.

Nevertheless, at this time, the application of ABA was rigid and unnatural. Children were required to sit through multiple, repetitive drills to learn skills and sequences, and the number of hours of intervention were exhausting. The popularization of his methodology created a mindset among some parents and providers that intervention must be highly structured, rigid, adult-driven, and sometimes, aversive, meaning treatment could involve unpleasant techniques to alter maladaptive behavior.

Evolving practices

Since the early 1970s, however, the world of ABA and the application of the principles of ABA have evolved enormously. Just like in other areas of healthcare, the field has progressed as more research has been conducted and newer strategies developed. ABA has evolved into a much more naturalistic, engaging, play-based, and child-directed form of intervention. In natural environment teaching (NET), for instance, treatment takes place within the ordinary routines of daily living, occurring during mealtimes, playtime, bath time, community outings (like a trip to the grocery store), and other natural parts of a child’s day. This sort of real-life teaching differs extensively from the overly formal, clinical settings of the past.

Today’s ABA programs should be tailored and customized to the needs, values, and culture of each child and family. ABA services need to involve choice-making and person-centered planning, in which each client and family steer and help make decisions about their target goals and treatment, and what fits within their family’s culture. Ultimately, every client and family need to decide what goals to target in therapy, with guidance from the behavior analyst. As in other areas of healthcare, research and best practice standards guide the strategies, techniques, and intensity of intervention. It is the combination of professional expertise and family input that aligns to create the most effective program for each child.

Consider, for instance, a conversation I had recently with the mother of a non-verbal child with autism who communicates regularly with noises one might describe as grunts. A behavior analyst wanted to use ABA to reduce that particular behavior, but the child’s mother did not agree. “Those noises are my child’s language,” she explained. The mother explained further that with each goal presented by her ABA team, she asked these questions:

• Does the goal respect my son’s privacy?
• Does it foster his independence?
• Does it cultivate his voice and self-expression?

The mother, in this scenario, knew what she wanted for her son—and advocated effectively for him.

Other parents I’ve talked to celebrate the skills and capabilities their children gained through ABA services, attributing their children’s gains to the dedication of their ABA providers. Many of these parents stress the importance of making sure the goals and strategies they were advised to use fit with the culture and parenting philosophy of their family. Not every parent or caregiver will advocate in this way or have the time and capacity to manage their children’s program. It’s up to us, as a profession, to honor and respect each client and family’s wishes and values, and to discuss issues related to things like dignity, individuality, and self-expression. It’s up to us to honor self-hood.

As the population of individuals with autism is aging, we now have a group of adults who received ABA services and wants to articulate and share their ABA experiences. I urge my colleagues to stop and listen—and use what we learn to inform the future of services. For example, some adults have articulated that making eye contact is physically unbearable, and, yet, this is one of the core skills ABA practitioners teach as a foundational part of learning.

Given what we’ve learned, it’s time to examine the degree to which each of the skills we teach benefits and serves individuals with autism, despite the fact that we may consider them appropriate social and communicative behaviors. In other words, we need to weigh our own self-interest as a society against what we’re learning from the individuals to whom we’ve devoted our careers.

Stay tuned for Dr. Molko’s upcoming story, where she offers advice on what to look for in a quality provider.