Is Alfie Kohn's Assessment of ABA Accurate?

Ready to learn more and engage in philosophic doubt, Mike and Dan take on a recent opinion published by the well-known education writer, Alfie Kohn. Kohn lends an eloquent criticism of ABA, pointing to recent meta-analyses that aim to question, if not eliminate, any socially significant effects and benefits of ABA-based interventions, as used with individuals with Autism Spectrum Disorder, for example. Kohn's arguments are carefully examined, credited where deserving, and aptly corrected in an effort to preserve their value, while rectifying errors in terms. That said, ABA has a wealth of empirical research and validation highlighting its effectiveness and value. However its implementation, like any other active system,  can always benefit from examination, improvement and evolution toward a perpetually stronger ethical integrity. Mike and Dan offer thoughts, insights and discussion to posit ABA, its current strengths and future directions.

ABA on Tap is committed to providing you with a clean 'pour' on this philosophy of a science in practice, ABA, and the facts surrounding its active implementation given our daily study and professional experience. We invite Alfie Kohn to join us and discuss his views further on a future episode and we value his prospective effort in listening and exchanging knowledge. His article, as discussed in this episode, can be found at https://www.alfiekohn.org/blogs/autism/.

Thank you for tuning in. Please do send us your comments and questions on Facebook. Finally a quick THANK YOU to LANTERN GIRLS for our new outro music. 

And always analyze responsibly. 

Transcript

SPEAKER_00: 0:00

Welcome to ABA on Tap, where our goal is to find the best recipe to brew the smoothest, coldest, and best tasting ABA around. I'm Dan Lowry with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA on Tap. In this podcast, we will talk about the history of the ABA brew, how much to consume to achieve the optimum buzz while not getting too drunk, and the recommended pairings to bring to the table. So without further ado, sit back, relax, and always analyze responsibly.

SPEAKER_01: 0:54

All right, and welcome to another installment of ABA on Tap. I am Mike Rubio, along with Mr. Dan Lowry. Dan, how you doing?

SPEAKER_00: 1:05

Excited about today's podcast, sir.

SPEAKER_01: 1:08

Man, let's just get right into this. One of the things we did last season during our first season is entertain criticisms of ABA by a very eloquent young woman by the name of Chloe Everett. We won't say too much more about that, but we're excited to revisit another set of very eloquent criticisms on ABA by a Mr. Alfie Cohn, whose name was You probably recognize if you're into education literature, very, very prolific writer who at some point last year, January of last year, took ABA to task, again, very eloquently, we might add, on his website. And we'll have all this information ready for you guys on the description of this episode so you can check it out as well. So we'd like to take a little time, since he honored us with taking time to criticize ABA, We want to return the favor. We wouldn't be taking this time if his criticism wasn't worthwhile. So just like he's doing for ABA, you wouldn't pick on ABA unless it's worthwhile, right? It's something that's going to bring you some notoriety or some attention for picking on something that's notable or the big guy, if you will, which we kind of are in many ways. He alludes to that in his article. So I think our... Objective today, and please, Mr. Dan, add any, pepper in any details here, is to honor many aspects of his criticisms, but before we do and before we can learn from them, we need to offer Mr. Cohn some corrections about applied behavior analysis. Anything I should add to that there?

SPEAKER_00: 2:46

Yeah, our overall goal is just to get a better understanding of his criticisms, what's true, what's not, so that we can better progress our services towards individuals with ASD or any individuals that might receive ABA services. treatment. So we encourage him and or his constituents or followers to listen to this podcast, reach out to us, and we would love to have a discussion so that we can all educate ourselves further and better the treatment of any individuals that we might serve.

SPEAKER_01: 3:17

I like that. I like that a lot. Again, the real objective here is to learn from each other. And I can't say this enough. At the end of this, before we're done today, we will highlight many things that Mr. Cohn says in his article here, the one we're referencing, that we should... very much listen closely to and figure out ways to modify, to evolve, to adjust. So, that's going to be the most important part here. But let's jump right into the technology, to getting on the same page. Immediately, one of the things that I think is concerning for anyone lending a valid criticism of ABA or a criticism of anything is to make sure that you've got a specific relatively good understanding. I know we're big on technology, so one of the things that I want to jump right into, and I'm going to hand it right over to you, Mr. Dan, is the interchangeability, or at least the way it's used in this particular criticism, of words like reward and positive reinforcement. I know why that's problematic. Let me hand it over to you, and please break it down for us. When you hear somebody criticizing ABA, ABA doesn't work, ABA is faulty, ABA And then they're using words like reward and positive reinforcement interchangeably. What does that tell you, technologically speaking?

SPEAKER_00: 4:40

That tells me that they don't fully understand the concept and that they understand maybe like a surface level understanding of what ABA is. And they're looking at rewards specifically as like probably a tangible item. You do something for me and then you get something tangible, which probably Could be accurate in some regards, but it's very, very limiting. You know, that's like saying you go to the Apple store and you get an iPhone. Yeah, they have iPhones, but they also have computers. They have all sorts of other things as well. So we would look at reward typically, again, as some sort of tangible, almost bribed item, whereas reinforcement is anything that happens after a behavior that increases the frequency of that behavior in suit. in similar circumstances and positive meaning something is added. So when, when he says that, uh, as a rule, the war, the more you reward something, the more they tend to lose interest in it. Again, that's a very kind of surface level. That's a very, um, that's kind of a lazy, uh, argument on his behalf or, uh, a misunderstood argument because, um, positive reinforcement could be something like parent parental attention, um, or even the self-satisfaction of doing well on a test. So these are all things we would promote in ABA. We are constantly trying to do what we would call fade artificial reinforcement, which is I think what he's referring to as rewards, into more natural reinforcement, just getting good grades or things like that. So that would be the biggest discrimination I would make there, that reinforcement is anything that increases a behavior, positive reinforcement being something that's added. And it doesn't have to be something tangible. And any behavior that's reoccurring has some level of reinforcement added. So when he says, if the more you reward people, the more they lose interest in it, that's... Lazy at best, incorrect at worst.

SPEAKER_01: 6:45

And he's really referencing the idea, or I guess the continuum between deprivation and satiety, right? Yes. Yeah, so we won't get too much more into that. And to your point, Alfie Kohn doesn't like the idea of grades either, but he does like the idea of our shift into a more... intrinsic motivation paradigm, if you will. And that's something that we'll get into later in the episode here because that is a valid point that he's making. Really quickly, Dan, in ABA, I'm hard-pressed. Do we talk about rewards at all, technologically speaking, in applied behavior analysis?

SPEAKER_00: 7:26

Probably not. in that term uh right maybe when maybe when talking with parents parents might use that but we don't typically use that term reward uh

SPEAKER_01: 7:38

yeah the only reason i bring that up is that again further in this criticism and we're being very careful here we're giving it a thorough job thorough inspection job uh you know this assertion that uh aba now imposes rewards with special needs students. And my contention there is, well, Mr. Cohn, ABA doesn't even talk about rewards. So how is it that we could be imposing this notion of rewards on special needs students? Now, what he's really referencing there is our presence in special education. What are your thoughts on that? What was your overview on his criticism there?

SPEAKER_00: 8:19

Yeah, my initial thought is that A parent that gives into a child for, you know, screaming because they don't want to hear the kid screaming anymore gets escaped from that kid screaming. Is that a reward for the parent? Well, yeah, they're getting a reward. If you want to put it in that context, we would call it negative reinforcement. He would call it a reward, but that is kind of across the board. So that's not even an ABA, an ASD specific thing. So then when he tries to lump us into these people, like you said, they come into schools and offer rewards to get kids to do things that we want them to do. And then do that with the premise that that's different than how typically typical education works. And he also likes, like you said, references the lack of need to give grades, even though we need some quantifier for success, right? You don't just want to send your kid to school for 18 years with no quantifier of success. So even if you're doing like a self report or something like that, that would still be some sort of grade metric. The more he tries to kind of say that it's different and say, Oh, well these ABA people are coming in and they're treating people with ASD differently because they have ASD and offering rewards and carrots on a stick and stuff like that. Yeah, no, that's, that's not, that's just a way of rewording. and looking at things that are happening in typical school under a different context.

SPEAKER_01: 9:52

I had a hard time. There's different questions I want to bring up here. One piece is how prevalent are we really in special education systems right now? I know that a lot of the concepts have kind of made their way, but I mean, there's not even legislation anymore that sort of mandates that somebody's board-certified behavior analyst to be creating things like, I guess they're all behavior intervention plans now, or I forget the language. But, I mean, how prevalent are we, like, for Mr. Cohn to put us into this whole subset as though we dominate special ed? I mean, is that a fair assessment? Oh, not at all. Right? Yeah, not at all. Where does

SPEAKER_00: 10:39

that come from? There's a few school districts in our general area that have behavior specialists or BCBAs, but those are definitely few and far between. It's still not general school practice to go to a BCBA for those behavioral needs.

SPEAKER_01: 10:57

Yeah, you know... Again, in sort of looking at the idea of empirical validation, I love these little pepperings of things like one California teacher saying that almost all programs in special education are based on ABA. You know, a lot of these little things that really add more to a sensationalism and, in my opinion, detract from the real value of Mr. Cohn's criticism of ABA, which, again, we'll get to a little bit later. One interesting criticism that Mr. Cohn lends is this idea of us, ABA as a field, blaming the reinforcement protocol or whatever reinforcement schedule we had. So when a behavior manipulation fails, he says, we blame everything else except the very science. And it's an interesting way to provide a criticism here, again, of a philosophy of a social science, we like to say, because he's almost suggesting that if a behavior protocol fails, then we wrap it up. We pack up and say, oh, well, this fails, as opposed to continue to try and build a relationship and rapport with the child, which he criticizes for not doing. But that is part of the process, right? If something fails, you keep trying something different. It's not like a scientist or as good educators, we're just going to stop trying to reach something. the child. And, you know, it's interesting for him to be lending this criticism in this very article, knowing that what he's celebrating is the 25th anniversary of his book, Punished by Rewards. I mean, if you're still able to create interest or garner interest on this criticism 25 years later, either your criticism hasn't stood a whole lot of validity over time, or maybe we've succeeded over that time, given how many people are receiving ABA services through their medical insurance. And, you know, certainly in my pretty lengthy career now, I know that I don't have any clients coming back to me with any of the maladies that Mr. Cohn discusses that we might, you know, elaborate on a little bit further. But it's really interesting in... Sort of a self-defeating argument he presents. Well, if you apply behavior procedures and they don't work right away, well, that's because ABA is faulty. Don't try anything different. A really interesting way to provide a criticism.

SPEAKER_00: 13:30

Absolutely. I think that almost violates the exact fundamental assumption of science of philosophic doubt, right? Absolutely. Of constantly questioning what you're doing rather than just throwing everything away. questioning, hey, if we have the mom, if the kid will listen to us and not listen to the mom, does that mean ABA is wrong? Or does that mean there's certain environmental contingencies that are present with mom and not with us or vice versa? That philosophic doubt that always questioning things. It seems like he's almost violating that in in some regards by just saying throw it out i guess what he's getting at is trying to say well instead of having philosophic doubt of the individual procedures have philosophic doubt of the entirety of the science the science has been pretty proven uh across various species um including humans over many many years as you talked about of his 25 year celebration yeah if you're if you're still you know honking your horn 25 years later with the same Um, critiques, maybe you should look in the mirror and, uh, figure out what are your critiques wrong. Um, are you maybe a little misguided? Why is everyone else? Um, why is this methodology exponentially more prevalent and popular now, 25 years later than when you started the critiques? Because if your critiques were correct, shouldn't it be much less popular, uh, 25 years later, because people would see the light, so to speak, uh, Um, granted, you know, there are certain people that are going to see the light, but you could go to a five-star restaurant and you'll get a couple, you know, bad Yelp reviews. So that, and then also like, like you brought up the point of you've been doing ABA almost 20 some years now that a lot of people haven't come back to you. I would like to think as a field, we've progressed over those 25 years. So do we get any Any credit for that that maybe we've learned and we've taken some of what you said over those last 25 years and addressed it? And actually, we are progressing in part thanks to what you brought up and what you acknowledged. In addition to, do you have a better suggestion? Because if you do, I'm sure insurance companies would love to hear it, especially if it's evidence-based because they don't. want to pay ABA for the duration of an individual's life, if you have a much better cognitive or whatever, I think you mentioned RDI in his article or things like that, if you have a much better scientifically proven more efficient methodology that will not have a book written about it about unhappy people that sustains 25 years later, I'm sure people would love to hear about that methodology as well.

SPEAKER_01: 16:17

So let's take a step back. We've covered a lot of ground already. And I'm going to try to piece together a little timeline here, knowing that he's lumped us in with special education. It's not education. It's not special. He makes that crack. And that's really not about us, again, because we're trying to become more prevalent there. But when we're talking about... Obviously, I do not take the idea of ABA somehow being a major factor in the... diagnosis of post-traumatic stress disorder later in adulthood. I'm not okay with that notion, whether it's real or not. I don't want that to be happening to people. But in terms of progress, knowing that at the inception of things like the Individuals with Disabilities Education Act, 1969 or so, a couple years before Lovaas over at UCLA starts doing something to... help integrate certain students who behaviorally and academically aren't performing in the way we'd expect. If I understand correctly, and we can have the fact check, we can fact check this later, but it was like a 90% chance in 1969 of somebody with what we would perceive now as ASD traits and features ending up institutionalized. So historically speaking, we don't have those institutions anymore, thank goodness, not the way they were in 1969. They do exist in some way, shape, or form. But knowing that that, you know, Lovaas quickly, 71 and then beyond, clearly had an impact in trying to get into education and even trying to present ABA as general learning theory that is embedded everywhere in educational strategies and procedures and techniques, clearly changed and leveled the playing field, quickly allowed all of us to say, hey, wait a minute. These differences or exceptionalities we've been regarding actually all fall under the same learning theory. And like we like to talk about often, it's all about engagement and then some level of encoding through repetition so that the learning can be solidified. It can be formalized a little bit. And then the generality part, which again, Mr. Cohn does make a good point about, we'll get to later. But There is a semblance of progress there that historically we fail to see if we don't look at it this way. ABA has had a... And again, not even being as prevalent in the school as we'd like to be, it already has had a very, very clear impact in the way students are integrated, for example, or in the way we even perceive any individual's learning ability.

SPEAKER_00: 19:15

Yeah, that's... Absolutely. And the other question would be, what metric are we using to determine an individual has PTSD? Are we sure that that's an accurate metric? And if there has some level of self-report, which I would presume that it would, would these individuals be able to report and have those methods of communication, if not for the ABA? Or would they be institutionalized with no means of functional communication? And which is a better... a better outcome. Go ahead, Mike.

SPEAKER_01: 19:51

Yeah, again, we're asking really tough questions here, but important to note that there's, yeah, what's the metric? How are we measuring progress? One thing that is a little bit cumbersome here in this criticism of ABA that Alfie Cohen puts forth is sort of immediately attacking the idea that the research methods and that You know, years and years of applied behavior analysis research is somehow worth nothing based on this new meta-analysis that he presents and read through. And then somewhere later in the article, you know, talks about us touting that we're evidence-based. Well, yeah. Yeah, we are evidence-based. Why is that a problem? How is it that we get to that being a... you know, a criticism of ABA. It's evidence-based and insurance companies are willing to reimburse for it. And it's part of the medical table now. Yeah, that's a problem. What do you think his angle is there?

SPEAKER_00: 20:56

I don't know. It's tough to say. I would like to think it's altruistic and just hearing, feeling like ABA is the bully on the block and bullying people to um, get their service. Um, that's what I would like to believe. It's also, um, you can absolutely make a name for yourself being a critic of, of something. And, you know, that's, that's another way to, to get your material out there and, and to make a name for yourself. So I, I honestly don't know what the, what the angle is. Um, but it's, it's really, all I know is that when I, I have had a lot of medical issues and when I go to, uh, the hospital to get certain things done. Insurance companies are really, really quick to deny all sorts of services based on all sorts of different reasons. The last thing they want to do is provide or pay out of pocket for anything that they don't deem absolutely necessary. And for an insurance company to say ABA is necessary and pay the amount of money and funding they do, it seems like there would be a lot of substantiated research, proven results, generality. They can go across people, places, settings, all of that, for insurance companies to even consider doing it, much less expand their ABA funding over the course of the last five, ten years, especially in our state since the California mandate.

SPEAKER_01: 22:24

So that's an interesting premise that Mr. Cohen puts out there, the idea that ABA is mandated. Let's talk about that for a second, because he puts it out there as though... Yeah, I'm not sure exactly how to describe it. He puts it out there as a real negative. Now, where is ABA mandated per se? Can you shed some light on that there? What does that mean when either Alfie Kohn says it's mandated or when you use the word it's mandated? What is it you're talking about?

SPEAKER_00: 22:59

Yeah, I don't think it's mandated anywhere. What California did was say, hey, we looked at the research and And ABA is an evidence-based methodology. Autism is a medical diagnosis. So we are going to mandate that insurance companies pay for ABA if a parent wants it. It doesn't mean they can't get any other sort of service on their own dime. They can absolutely do that. It's just they've shown that ABA is the most effective so that... the government and now private insurance companies are mandated to pay for it. So in no way is anyone mandated to receive ABA. When I use the word mandate, it's the funding sources are mandated to provide it for those that want it.

SPEAKER_01: 23:43

Yeah, and I think in the description put forth here in the criticism, it's almost as though it's forced upon people. Now, the literature very clearly states it's empirical validation, it's power. So in that sense... Yeah, you know, insurance companies are saying we will reimburse for those services that are based on that power and, you know, a few things else. But what we fail to see here is the umbrella of ABA, right? Mr. Cohn mentions, I think we... mixed up a little earlier, calling it RDI, but he actually references DIR floor time. Sorry, yeah, I got that backwards. That's okay. These acronyms get difficult. Same letters, just that. Exactly. These acronyms get difficult. And in that sense, looking at something that has value or that uses applied behavior analysis procedures, maybe basic contingencies... and ascendant behavior consequence, looking at motivating operations in terms of floor time, how you play with a younger child. So floor time does have a lot of value in my opinion. The limitation for this criticism is that it's really for younger children. So it has an age limitation as far as I understand. So, you know, Mr. Cohen offers that as one, you know, grossly ignored alternative. I don't think it's ignored. I think it's maybe even made its name into certain funding sources as something with empirical validation. But it doesn't mean it's devoid of applied behavior analysis principles. Roots or contingencies or procedures. And there's a whole bunch of other acronyms and letters we can throw out that are completely empirically validated, have a beyond single subject study validity. Things like the early start Denver model, which is. largely, largely rooted in applied behavior analysis when you read through those manuals, even by admission of those particular authors and researchers. So I'll hand it over to you because you could probably elucidate and name a whole bunch of other treatment procedures, treatment strategies, treatment packages that are directly rooted in applied behavior analysis.

SPEAKER_00: 25:59

Yeah, I think one of the newest ones being Pivotal Response Training. Kegel and Kegel and Schreibman looked at some of the criticisms that Cohen made, but also others, and said, okay, maybe ABA is a little too robotic, is a little too lab-based, is a little too repetitive, a little too first Benny, and said, all right, let's take it into the play realm. So that would be another example of an ABA-developed procedure, not ABA, but an ABA-developed procedure that's highly utilized. Even occupational therapists that I've been working with lately have a lot of ABA strategies, ABA strategies behind them. So, yeah, are certain parts of ABA, are certain implementations of ABA maybe not the best? Are certain implementers of ABA? Maybe, probably not. There are certain doctors that are out there. With the opiate crisis, there were people that were milling opioids all over the place. Do we just say, okay, we're not going to do medication anymore? Medication's not good? No, they found the people that were doing it incorrectly and said, these doctors need to go. Not medication itself is terrible. These doctors have to go. And that's the same thing with ABA just as any other sort of medical procedure.

UNKNOWN: 27:23

Okay.

SPEAKER_01: 27:23

Now, one thing we can relate to with Alfie Kohn here is that until recently, we were largely unaware of a lot of the ABA hate circles, if you will, to just say that explicitly. Because once we came upon some of these resources, it was like, wow, you guys really don't like me. you know, this whole field. And, you know, for us as practitioners who try to stay at the forefront, trying to be innovative, trying to educate ourselves continually, we take offense to that because a lot of the claims that are being made, we don't necessarily feel as individual practitioners and, you know, given our colleagues that we actually feel like that's why we're here right now. We're trying to turn the tide. We're inkling, semblance of those old stylings that still might be rooted or in deep antiquation and no evolution because we know they're out there. So, you know, to Mr. Cohn, yeah, okay, maybe you took a look at one or two or listened to these groups in particular about all the criticisms. But again, how many more people are actually receiving ABA services and doing well and feeling happy or feeling like it was a part of their ability to manage their own traits and to access their environment in socially significant manners. He makes this claim about The idea that comparing himself to having been an advocate for homelessness and finding out that some of the biggest critics of his efforts are the homeless. Well, who else would you... think would be the biggest critics? The people that are receiving your services. Why is that so surprising, right? If you're at a restaurant and somebody comes in as a food critic and eats your food, well, that's the person who's going to be able to critique your food. So why is it so surprising that people that are receiving... It's like, you know, how many people...

SPEAKER_00: 29:27

Yeah, I wouldn't expect car mechanics to be the biggest critics of ABA.

SPEAKER_01: 29:32

So, you know, and then to... To the point of something medically caustic or challenging, if you will. We're no strangers to these types of treatments personally, but things like chemo, I'm sure nobody has wonderful feedback on chemo. I don't want to make this comparison too strongly. I don't. But did it work? Yes. Was it trying at times? Was it easy? Well, no. Change isn't easy. Now, again... Not saying that to justify any sort of harsh or antiquated methods of ABA that are still out there. That's why we're here right now and doing this podcast actively to try and promote the evolution. But again, I felt that some of that criticism there certainly fell short. It's like, well, yeah, who else would you expect to criticize ABA? You know, it didn't make much sense.

SPEAKER_00: 30:28

Yeah, yeah. Nor did... the critique of it being dehumanizing and infantilizing, I believe is, uh, uh, infantilizing. Sorry. Um, that's yeah. Okay. Um, compared to what compared to before there was ABA, there was institutionalization. What's more dehumanizing putting somebody in an institution, uh, or like a high level group home where they don't see anybody else, uh, or some level of ABA again, not saying, uh, that there aren't some ABA practitioners that, you know, Stanford prison experiment, you give people too much power. Some people will abuse it. Not saying that doesn't happen. Uh, but as a practice, as a scientific basis, because he's saying ABA does this, not certain ABA practitioners. And I think I really, really want to reiterate this. If you were to say certain ABA practitioners do this, we'd be his biggest supporters. He'd have us on and we'd be like, yep. We hear about some stories in ABA and we're, we're like, oh my Lord, that is terrible. But when he says, yes, when he says ABA as a field is dehumanizing, really? More so than an alternative of institutionalization that that's what it was before ABA. A lot of these individuals that are expressing their concerns about ABA may not have been able to talk and have the functional communication to express their concerns without ABA. Again, like you said, was it all roses and flowers? Probably not. Um, and we can continue to improve that, but let's also take a second and say, well, yeah, it was hard. Like you said, with chemo, which I know all too well. Um, but you, you got to the end result and you'll look back and you'd say, well, given everything I've everything I have now, what I do it again. I think the vast, vast majority of people, parents would, would say yes. Um, it also, he also talks about ignoring internal realities and, and undermining intrinsic motivation. Specifically, he says, employees who are promised bonuses for meeting certain criterion find their work less satisfying. Again, a big overgeneralization. Are we saying that we shouldn't offer people bonuses for hard work? And then we're always looking at ways to, we would call it indiscriminable contingencies or varying reinforcement, taking it from You'll get this if you do this to making it more natural and indiscriminable so individuals get reinforced without having to hold those carrots on a stick. So there's a lot of things that he mentions that I feel like is either incorrect or just misinformed or just lazy with the whole dehumanizing aspect. Again, it's really, really easy. Everybody does it. A lot of people deal with politics now, right? They just... Whoever is the current politician, they have nothing but bad things to say about him. But it's like, what would you do if you were in their shoes? What would you do differently? What's the better option? And that's so much harder to come up with. So yeah, it's really easy to jump down our throats and say that these things aren't the best. But until you can come up with a better option, why don't you work with us instead of work against

SPEAKER_01: 33:41

us? And that's the big point here. Because ultimately, again, there is value in what mr cone is saying and that's what we're saying to him is we're offering correction and then once you understand these things we want to highlight the value of your criticism because yeah we need folks like you offering uh this type of feedback but in a way that's constructive in a way that actually actually honors the empirical validation that that that You know, we've paid our dues in that sense. The idea that you're just going to come poo-poo our empirical validation based on one meta-analysis, not fair. And what we're saying, Mr. Cohn, is we know you're smarter than that. And you've got a wider reach. So let's get this right. We need to shift gears here just in the interest of time. So I want to put out one last, at least for myself, one last... correction, to be direct. We got special guests. I like it. Dan, have you talked about curing autism with ABA? Alfie Kohn makes a pretty direct allusion to sort of proselytizing as though we We've got to cure. What's your feeling on that? I don't think we do that. I vehemently disagree with that stance because we're about socially significant behavior. We're about looking at ways to improve the generality of our outcomes in terms of socially significant access. Curing autism? I don't know that in my almost 25 years of doing something in or around this field that's ever really been embraced by and large.

SPEAKER_00: 35:35

Yeah, I've never advocated for that. In fact, I advocate and I kind of laugh at the diagnosis of autism because just like as ABA would say, circular reasoning, right? How do you know someone has autism? Well, they have social delays, communicative delays, repetitive behaviors. Why do they have those things? Because they have autism. You don't even get anywhere. So ABA... makes an overt effort to not even look at the ASD diagnosis. So that's essentially irrelevant. I won't even bring that up to parents in terms of autism or things like that unless parents bring it up to me. So I've never brought that up. It's never been a goal of mine. ABA is so much more versatile than that. Yes, we've gotten lumped into the ASD field, but there's so much research on ABA and schizophrenia and PTSD online on all OCD, on all sorts of other diagnosis. And it's applicable for individuals without diagnosis as exemplified by the California Early Start Program that we're working with clients currently giving ABA procedures and they don't have a diagnosis. So yeah, in terms of the cure, in terms of us getting somebody, looking at them as less than and saying, oh, well, you need to do what I say because you're less than and be more like us. No, it's your parents come to me and say, we're having a difficult time managing or individuals themselves because we have adults say that I'm having a difficult time finding a girlfriend or finding a job or something like that. Can you help us? And we come up with ways to help these individuals.

SPEAKER_01: 37:15

The general notion that... So let's start shifting gears here because, again, there's a lot of value in the criticism, and we want to really end on that note is, Mr. Cohn, you got a good point here. Help us out, okay? Let's figure out a better way here. You mentioned early start, and one of the things that you know that I've been very active in trying to combat is this idea of one ABA based on discrete trial training, which... you know, most of us was sort of our introduction to the field. You know, I think that's pretty fair to say for almost most practitioners now. And there's some habits that have been formed in such procedures that, as I explored things like early start for kids under three and this idea that these are kids at risk, to use that phrase loosely and quickly. So, The ABA we've known so far for kids with ASD, again, we could probably talk a long time about the misappropriations there or the overgeneralizations there. So my contention was we have to do a different ABA. And one thing that Mr. Cohn does mention, and he phrases it in a way that's a little bit sensationalized, but again, the content is it need not be ignored. This idea of conditional acceptance, that In order to perpetuate trials at times, we might hold items for ransom. Right? That we might snatch items away in order to perpetuate the next trial. You know, I hate to have to admit it, but he's got a point there. What can we do differently? Why is it that that habit came about, in your opinion... And how do we combat that, knowing that you and I have got experience just a few hours ago talking about this all day, and now we get to talk about it here, so I'm excited about that direct transfer. Because it is an important shift, and it's not an easy one, and most of the resistance we're facing is from ourselves, right, and our old habits. So what are your thoughts on that, Dan?

SPEAKER_00: 39:31

Sure. I think the first immediate thought is, well, that just sounds like life, and that sounds like a job that's going to hold my pay for ransom until I do what my job description says that I'm going to do. So there's an element of that that's just life, and that's life. So it's something that you need to learn to understand. As for specific to ABA, I know we're making an active– at least our company, we're making an active intention of trying to eliminate that concept of taking something and withholding it and making it contingent. A lot more play-based therapy, a lot more, oh, you're playing with a car? I can show you something cool with this car. Oh, you don't want to do that? Okay, you can play with the car the way you want it to. I'm going to do this cool thing over here. Oh, you're interested now? Let me show you the cool thing. Oh, you're still not interested? Okay, then you can go back. And imitating them, following the child's lead, much more so than coming and taking the car from the kid and saying, do your homework, then your car. Much more functional, kind of like you would see in a typical preschool classroom of teaching through play and child-led learning.

SPEAKER_01: 40:41

Right, right, exactly. And I think, again, the value there being that, by and large, we can feel comfortable with efforts every day that we're doing, not necessarily... Getting that feedback or that quick acceptance or reception from all colleagues, knowing that it really shifts the paradigm. How do you really gauge, measure your data if you're not doing this discrete trial that starts and finishes this way and you've got this prompting hierarchy that you've been implementing? We've certainly been trained in a very specific way that leads right to this notion that Alfie Kohn talks about in sort of ABA leading to teachers, I think specifically he says, becoming more controlling. Now again, as much as I hate to have to look at that and be like, okay, he might have something there, he might have something there. And what he's describing here in our perpetuation, our efforts to perpetuate trials is, by and large, what I see is part of what has led to that misapplication of ABA. He goes on to talk about the use of controlling backfiring. And then you mentioned this earlier that we overlook intrinsic motivation and we place our dependence on external sources. By and large, not entirely untrue. but not a good general statement to make because we do differentiate this quite a bit. And it is our effort. And it's been the field's effort for a long time now in saying, hey, our generality needs some help. So we know that. And that's why this discrete trial is now becoming embedded into much more naturalized ways of interacting. So what do you say about that? I mean, he's got some points there in terms of of what a misapplication of ABA procedures, if you're just looking for simple compliance, yeah, this could happen to you, unfortunately.

SPEAKER_00: 42:46

Yeah, yeah, there's validity to that, right? Back to that Stanford prison experiment. If you're looking for simple compliance and it's you do for me or else, then yeah, that can absolutely be misapplied, abused. I would like to think, though, if it's being abused, it's kind of on us, but it's not really on us to acknowledge that. It's on the parent or the individual themselves. But typically the parent to say, hey, I don't like the way this is going. This doesn't look right. Obviously our goal is not to do that, but it's also on the parent or guardian to be kind of the overseer of said policy. So, yeah, clearly it could be abused. That is something that we... We are actively trying to combat. Just today we were talking about getting rid of a receptive instructions program for a younger client, something we're actively trying to combat and make things more child-led, more functional, more generalizable. These are all things that ABA is active. I think if you were to even just take, like you mentioned, DTT versus PRT, the 10 years of evolution from one to the other, if Alfie actually cared to look at that, I think he would be, hopefully, if his goal is to get, if his goal is as altruistic as he presents it to be, I think he would be pleasantly surprised with what he would see in the development of ABA. If his goal is to just criticize regardless and make a name, then it's going to be irrelevant because nothing we could do would alter his thought process. But again, if you were to look at the evolution of ABA as to what you're talking about, away from the compliance model, you need to do it now, and the conditional acceptance model, I think he would be really encouraged. And I encourage him to, like I said, come debate us. I encourage him to look at kind of what new ABA, happy to show him what ABA looks like now, and hopefully he can take it in and maybe make a, you know, after his 25th anniversary, the 26th can be something some book on how ABA is no longer punishing and how it's more of a reward system and, uh, you know, more, uh, humane and for, for all of the clients that we work for. Cause that's, that's what we actively try to seek is a more humane treatment model.

SPEAKER_01: 45:18

I like that the 26th anniversary. And I would love to, um, be able to chat directly with, uh, Mr. Alfie Cohn, again, very prolific writer. We don't take issue with all his books. We just take issue with this one article right now. And, Maybe I need to read Punished by Rewards and see what else he might say in there, knowing that what he was writing about 25 years ago is certainly not what I'm practicing now, speaking that as a professional who's been in the field about 25 years now. So there's been an evolution. We had to start somewhere from the idea that, you know, 1969, 90% of these people kids who would have now been regarded as having ASD would have been institutionalized. It started with an effort to evolve out of that very dark reality. So I would, yeah, I would very much want to invite Mr. Cohn to Talk to us about some of these innovations we're certainly making that we know other colleagues are certainly actively trying to make or understand a little bit better. And looking at things like a DIR floor time model and seeing how simple ABA contingencies fit right into anything you do. You have to gain attention. The child then behaves, and you respond in response to that behavior. You can't get away from that. So if you think something works... you can filter it through that contingency somehow. And somehow all this applied behavior analysis stuff we like to talk about, you know, ad nauseum sometimes, it applies whether you want it to or not. Just like you were saying earlier, if you're an adult with autism who's now very eloquently speaking about your post-traumatic stress disorder, having had ABA in the past, ABA is also inextricable from your success to communicate right now. Again, don't want anybody to have any nightmares about ABA, but that is the fact that in a multivariate analysis, if you had ABA and now you're doing a TED Talk, that ABA is part of that progress there. So trying to look at a good way to wrap this up, just in the interest of time, we've covered a tremendous, tremendous amount of ground issues. Closing points, Dan, I'll hand it over to you. What have we learned today and how do we want to end this?

SPEAKER_00: 47:45

We've learned that there are individuals that still are unhappy with the ABA services. Rather than complain anonymously or in groups and dissuade, we encourage these individuals to come speak with us. so that we can maybe present a different picture or they can explain their picture to us more thoroughly. Because basically right now, ABA is the gold standard. Look at companies like Autism Speaks, Autism Society of America, companies like that. They don't have a bone in the... They don't care what service gets provided. They just want the best for individuals with ASD. And all of them recommend ABA as the gold standard. So if it's going to be the gold standard... Let's work together with these detractors and figure out how we can make it even more of a gold standard. I guess that's just kind of my closing point. So rather than write these articles about all the things that we're doing incorrectly, first of all, find out if we're doing them incorrectly. Find out if it's an application issue or an overall issue. Let us know. Create a dialogue. That's all we're trying to do with everyone. is just create a dialogue, and hopefully that amounts to some meaningful change in people's lives.

SPEAKER_01: 49:10

Yeah, I think that as much as Mr. Cohen tries to argue this or argue against this, he has to mention it, the ABA is empirically validated, the gold standard, as you say, and if something is the best that a medical establishment can offer you with regard to your symptoms of autism spectrum disorder, yeah, before you negate it all and throw it all out, number one, make sure you understand the procedures correctly, right? I'm not going to go try to tell a neurosurgeon how to cut into my head unless I've studied neurosurgery thoroughly. And even then, I'm going to hang back a little bit because that guy's got 10,000 hours of surgery under his belt. I just stayed at a Holiday Inn last night, right? And I read a We encourage, more than anything, I think we've achieved our objective. I'm comfortable with it. We encourage Mr. Cohen or anybody else out there to get the technology precise, to come speak with us about how else it could be expanded, elaborated, implemented in a more humane manner, or however you want to put that. Certainly not opposed to the evolution. But as you learn how to speak about technology, and critique us more precisely using our technology and fully understanding it, yeah, we're going to be the first to listen, just like we did today. He makes that case that maybe we're not listening. No. Ido Kedar and Chloe Everett, all these people, we're listening too closely because we don't want anybody to feel nightmarish about their ABA experience or have some later comorbid diagnosis pop up because of that. We want this to... have the power that we know it has in empowering parents, empowering the kids we work with to access their environments in socially significant and, dare I say, satisfying ways, in ways that now lead to fulfilling, stimulating, enriched lives. Again, having done this for near 25 years, I know that I'm grateful that that's been, by and large, my experience. It has taken a lot of interpretation away Coming from a developmental psychology and a brain and behavior to a behavior front. I'm very thankful for that experience. So I do agree with Mr. Cohn. We have to evolve and apply all these things and not be so brute force about our application. But my final point being is, you know, don't don't throw the baby out with the bathwater. by any means, and make sure that we're preserving those things that are going to help consumers, that are going to help clients, are going to help kids and families access more and emit more socially significant behavior to access reinforcement from their environments, knowing that many more people are doing that than are vocally criticizing, and lastly, knowing that we're listening to those vocal critics to ensure that we're improving our efforts.

SPEAKER_00: 52:11

Couldn't agree more. I think that's a great way to end it. And we encourage anyone who wants to please reach out to us so we can create this discussion and better everyone's outcomes.

SPEAKER_01: 52:25

We thank Mr. Alfie Kohn for his very, very eloquent and harsh criticism of ABA that potentiated this podcast episode. And we can't say this enough. We invite him. to come and talk to us about these things so that we can further educate each other. Brother, always a pleasure. Cheers. Cheers, brother. Always analyze responsibly. ABA on Tap is recorded live and unfiltered. We're done for the day. You don't have to go home, but you can stay here. See you next time.