The Conservatives at Westminster recently made it clear that they have no intention of following through on their manifesto commitment to ban ‘conversion therapy’ for gay people. A few days earlier, the Scottish Green Party agreed on a policy to ban a set of closely related practices, targeted instead at disabled people.
Developed initially by some of the same people who pioneered conversion practices for gay and gender nonconforming young people, applied behaviour analysis (ABA) and its offshoot positive behaviour support (PBS) enjoy far more mainstream acceptance. So far, that includes support from the UK and Scottish governments, and use by some of the biggest autism charities, including Ambitious About Autism, Child Autism UK and Autism Speaks. Even the National Autistic Society recommends some of its techniques and is still actively recruiting board certified behaviour analysts.
Outside of disabled and especially autistic communities, it is perhaps not yet widely appreciated that these practices share an underlying philosophy and many practices in common with the so-called conversion therapy that the Scottish government has promised to ban.
The evidence
ABA, which is usually promoted as PBS in the UK, is sometimes claimed to be the ‘gold standard’ in autism interventions. However, a look at the evidence which is supposed to back it up shows a field riddled with undisclosed conflicts of interest, systematic failures to investigate possible harm, and a philosophy at odds with the mainstream of modern psychology.
Many of the autistic people subjected to these practices report that they found them traumatic, and that being trained to comply with whatever a responsible adult tells them, left them vulnerable to abuse and exploitation. Even with the help of all these questionable practices, systematic reviews of the available research have repeatedly shown that the evidence is weak for ABA even achieving the things that it aims to.
Meanwhile, professional bodies have been strikingly ineffective in ensuring even basic standards among ABA professionals. Behavior Analyst Certification Board (BACB), the main body operating in the UK, does not require practitioners to have any knowledge of autism. It is true that ABA is sometimes practised on other populations, but the BACB’s own statistics show that the overwhelming majority of practitioners work mainly with autistic children.
Over in the USA, where ABA is an industry worth over $2bn, an institution named the Judge Rotenberg Center has a long history of using machines strapped to its disabled inmates (mostly teenagers of colour) to deliver electric shocks for non-compliance. This practice was condemned by the UN Special Rapporteur on Torture in 2013. However it took until 2022 for the Association of Behavior Analysis International (ABAI), one of the country’s main professional bodies for the ABA industry, to vote to oppose it. Prior to that, ABAI had hosted representatives from this centre at their annual conferences every single year since at least 2012, often specifically to defend their use of electric shocks. The BACB, which certifies ABA practitioners in the USA as well as the UK, does not appear to have taken a position on this.
Is ABA ever OK?
Most ABA practitioners today would never use electric shocks, although ‘founding father’ of ABA, Ivar Lovaas, certainly did, in his pioneering attempts to cure children of both autism and gender non-conformity. Most modern ABA practitioners will insist they don’t use what they call ‘aversives’ at all, but critics will point out that they instead systematically withhold items that they know bring a child joy – something which is usually experienced as punishment; (see Punished by Rewards by Alfie Kohn). With no professional requirement to understand autism, many practitioners are simply not equipped to understand the effects of actions like this on the children they have power over.
Given all of this, it is no wonder that ABA is not supported by a single autistic-led organisation, and was recently condemned by Ireland’s Joint Committee on Disability Matters, stating that ABA and PBS “cannot uphold the UNCRPD [UN Convention on the Rights of Persons with Disabilities] on principles of autonomy, dignity, right to identity and freedom from non-consensual or degrading treatment”. What is more surprising is that PBS still maintains the support of several governments – including the Scottish government, which has otherwise taken a strong stand against so-called conversion therapy.
Positive behaviour support in Scotland
PBS was uncritically endorsed in the Scottish government’s 2018 ‘Coming Home’ report, chiefly aimed at getting people with learning disabilities out of long-term institutionalisation far from their homes. Following its recommendations, the Scottish government has since set up a PBS ‘Community of Practice’ for professionals interested in these approaches. Why would a government opposed to the use of behaviour modification systems on gay and trans people apparently lend enthusiastic support to such similar practices when they are applied to disabled people?
The most charitable reading of the Scottish government’s position would be that they simply do not believe that what they are supporting is the same thing at all – that when they say they support PBS, they don’t mean what the UK Society for Behaviour Analysis and PBS Coalition UK mean by it, but something else entirely. In response to a 2021 freedom of information request, one government representative asserted that PBS is “not a single intervention but rather the name given to taking a person-centred approach” – but then why persist in using a term that has long referred specifically to a set of practices derived directly from ABA?
The PBS course set up at Glasgow University with government support seems to use the term in its usual sense. It is safe to suppose that if local authorities and inspectorates try to follow the Scottish government’s lead on PBS, the practices that they approve are far more likely to be behaviourist than person-centred.
For many years, abusive conversion practices aimed at turning people straight were allowed to persist under the cover of ‘therapy’ for people who will struggle in a world that is hostile to people like them. The tide has started to turn against this, thanks to the true nature of such practices being brought out into the open. It is high time that behaviour modification practices directed at autistic and other disabled people faced the same kind of scrutiny, something the Scottish Green Party’s move might help to bring about.
