Despite direct feedback from autistic people about the harms they’ve experienced with applied behavioral analysis, or ABA, the Autism Science Foundation (ASF) has taken a rigid stance in favor of the “therapy.” It’s hard to understand why any organization that purports to be “dedicated to supporting people with autism and their families” would so persistently look away from these truly lived experiences of autistic people. My inference from outside observation over many years is that despite the claimed dedication to supporting “people with autism,” there is a disdain for and resistance to autistic people who dare to disagree with or push back against the grievance-parent–oriented positions the organization tends to take.

One of those positions is the stance favoring ABA. In support of their position, ASF offers a series of claims regarding ABA, along with some citations from the scientific literature that purportedly support these claims. The references cited are old – in some cases almost 20 years old – and in general don’t even weakly support the claims made, sometimes even directly countering them. In addition, newer studies encompassing more up-to-date and robust findings do not frame ABA as having any clear, evidence-based, cost-benefit balanced utility for anyone but adults who want autistic people to be more socially normative in their behaviors.

In fact, current evidence suggests that results for ABA-related outcomes are mixed, at best, with “positive” findings in randomized controlled trials (RCTs) only for a limited slice of outcomes related to “social communication.” Relatedly, the evidence suggests that caregiver/teacher (i.e., non-autistic adult) biases and impressions may drive the perceived social communication improvements. Finally, some researchers have called for more studies on and greater consideration of the adverse effects of these practices for assessing the cost-benefit balance.

Background on ABA

One point that ASF has attempted to make is that ABA strategies have changed in the years since its beginnings in the mind and sadistic practices of Ivar Lovaas, the acknowledged godfather of several forms of child abuse, including the foundational practices of ABA and conversion therapy. The original basis of ABA is that autistic children were not fully human and thus could be treated, quite literally, like rats. They were subjected to “operant conditioning” in which repeated negative consequences were used to “extinguish” behaviors viewed as undesirable in the eyes of the unimaginative, socially normative control freaks who embraced the practice.

From its inception, ABA grew into a huge industry, the “therapy” positioned as the only option covered by insurance in the USA and as necessarily requiring dozens of hours of intervention each week. This financially lucrative structure was ensured with the establishment of ABA-specific journals packed full of studies from ABA practitioners and sympathetic researchers, all usefully finding something “beneficial” about the practice of ABA. Adding to the shiny materialism undergirding these efforts was the establishment of certification processes for ABA practitioners and many, many ABA “clinics” across the country. It’s a profitable operation, and threats to this carefully ordered infrastructure tend to mobilize strategic resistance.

Among those threats have been revelations about Lovaas and reports from autistic people subjected to these practices as children. The upshot has been an attempt in the ABA community to pivot away from some of the more cruel practices and to reframe ABA as relying on “naturalistic developmental behavioral interventions,” or NDBIs, with “positive behavior supports.” Dropping in the words “naturalistic” and “positive” has been leveraged as a gloss on what remains the core and damaging practices of ABA: conditioning the autistic behaviors out of autistic children by manipulating them into conforming with the expectations of non-autistic adults.

Indeed, the manipulation with the “naturalistic” approach with “positive” supports is insidious in its falseness, employing “operant conditioned reinforcement of target behaviors by capitalizing on the child's interests in objects and activities.” The tactics are designed to make the autistic child feel as though an adult is authentically engaging with them and their interests, when the reality is that the engagement is false and calculating, all in the name of producing a conformity that eases the cognitive burden of the non-autistic adults.

In other words, it still involves treating children like rats, but in a sly, manipulative way by pretending to share their interests as a strategy to bribe them out of their autistic behaviors. Here’s a description of this pivot to enfluffication:

For example, imitation of a symbolic play act with a preferred toy would be reinforced by the child’s continued access to the toy and freedom to play as the child wishes (generally paired with social attention). This is in contrast to more traditional behavioral strategies that involve having a child complete a task (e.g., push the car) and then receive an unrelated reward such as a token, break, different toy or food.

Evidence suggests that these practices do not yield positive outcomes for the autistic children subjected to them or that extend beyond the context in which the therapy is administered. In other words, autistic children don’t gain skills in navigating the wider world when subjected to ABA; they are treated, still quite literally, as rodents to be “conditioned” to conform to non-autistic expectations. The crucible in which ABA seeks to forge their behaviors is as rigid and unforgiving as it ever has been.

The new terms have apparently led to some confusion when it comes to obtaining insurance reimbursement, which in turn has led to commentaries that carefully define NDBI as “still ABA,” lest insurance companies become confused and decline to cover the same old therapy dressed up in this fluffy, soft-focused new language.

The ASF position statement: a look at three key claims

There are three central claims in ASF’s position statement that deserve a closer examination.

The first claim

ASF writes:

Research has shown that positive behavior supports are most effective [NB: this applies in almost any context in child development], and the ABA field has evolved – and continues to evolve – based on a growing body of research (Frampton & Shillingsburg, 2020; Maye et al., 2020; Sandbank et al., 2020; Schmidt, Luiselli, Rue, & Whalley, 2013).

Here’s a breakdown of the citations offered to support this claim.

• Frampton & Shillingsburg 2020: This is a publication describing outcomes in two children. Two. It was published by practitioners at The May Institute, “a national leader in applied behavioral analytic services.”

• Maye et al 2020: This is a perspective (editorial) that basically confirms that engaging happily with children in mutual interests is a positive thing to do. In this case, however, the idea is to leverage playfulness as an entry point into applying ABA strategies. As you’ll see later, the real key here is being playful with children and letting them lead the way in play. In this context, though, “playfulness” is just a manipulative tactic in a continued attempt to rebrand ABA as “ABA-based naturalistic developmental-behavioral interventions.”

• Sandbank et al 2020: This publication was cited to support a claim of positive effects. Here’s what the authors actually say [emphasis mine]:

... when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome.

• Schmidt et al 2013: This is another case report, this time on one single child.

This list is the offered evidence base: one editorial, an analysis that found no effect in the most rigorous and low-bias study design, and three children.

Second key claim

ASF writes:

Hundreds of studies, reviews and meta analyses collected over 40 years of research have shown that the principles of ABA, when used correctly, can lead to progress in communication, language ability, cognitive ability, academic skills, adaptive skills, and social interactive behavior in autistic individuals (Helt et al., 2008; Rodgers et al., 2020; Smith & Iadarola, 2015; Weitlauf et al., 2014).

A look at each citation in that list suggests less than sturdy support or even conclusions in opposition to this claim.

• Helt et al. 2008: This one is an 18-year-old review entitled “Can children with autism recover? If so, how?” and uses the term “mental retardation.” Yikes. At any rate, these authors rely almost completely on another review published that same year for the ABA-related discussion. That earlier review found that Lovaas's behavioral treatment (the OG ABA) met “criteria for well-established,” which meant that it involved a treatment manual and clearly specified participant groups (a low bar). Helt et al. themselves highlight confounders in ABA studies and write that:

… none of the studies found significant treatment differences between the children who moved off the spectrum and those who did not.

• Rodgers et al. 2020: The conclusions of this one – yet another review – do not support the claim made. The authors write that:

Although the IPD meta-analyses have shown small to moderate improvements in child cognitive ability and adaptive behaviour for early intensive ABA-based interventions relative to TAU or eclectic interventions, all of the identified studies were at risk of bias, limiting the conclusions that can be drawn from these results. Furthermore, individual study results varied considerably, with some showing no relative benefit of early intensive ABA-based interventions compared with TAU [treatment as usual] or eclectic interventions. Crucially, there is also a paucity of reliable longer-term follow-up data from children who have received early intensive ABA-based interventions. There is no clear evidence on whether or not any comparative benefits of intervention are retained through childhood, if interventions alter the course of a child’s education, or if it has any impact in adulthood.

• Weitlauf et al. 2014: Also not exactly a full-throated support of the claim:

… our confidence (strength of evidence) in the effects of ABA-based early intensive approaches on cognitive and language outcomes is moderate, based on the need for additional research that identifies which groups of children benefit the most from specific high intensity approaches. Our strength of evidence in these high intensity interventions to affect adaptive behavior skills, social skills, and core ASD symptom severity is low. At present it is challenging to understand which approaches to high intensity intervention have the greatest effects for specific children.

• Smith and Iadarol 2015: This is another review, and the authors discuss ABA and a non-ABA intervention, the developmental-social pragmatic model, or DSP, in which therapy involves following the child’s lead. Based on this review, DSP shows as much promise or more than ABA, yet ASF does not mention it at all. Of note, the DSP approach involves less infrastructure, time, and money.

Third key claim

ASF writes:

These changes lead to meaningful gains in quality of life, like developing social connections and friendships (Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012), maintaining employment (Wehman et al., 2017) and improved independence (Hume, Loftin, & Lantz, 2009).

The context and implication of this claim suggest that early ABA therapies lead to these “meaningful gains” later in life. None of the cited studies are related to that context.

• Kasari et al 2012: This publication describes an RCT comparing two kinds of brief social skills interventions: peer- and child-mediated practices for autistic children in a school environment. ASF does not mention or emphasize these models or the authors’ findings that “significant improvements can be made in peer social connections for children with autism spectrum disorders in general education classrooms with a brief intervention, and that these gains persist over time,” which is quite different from “must have dozens of hours of intensive therapy in a special center over a long period of time” that is ABA.

• Wehman et al 2017: This study involved autistic adults who spent 9 months learning in a high-school workplace-immersion program (Project SEARCH) with some ABA elements added in. The outcome was whether or not the students had become employed and stayed employed within a year of graduating, with the vast majority of participants experiencing both outcomes. It is wildly beyond a stretch to claim that this study supports that ABA in childhood supports “meaningful gains” in maintaining employment later in life.

• Hume et al 2009: This publication is another review that (possibly inadvertently) highlights a key fault of intensive ABA: the potential for children to become overreliant on prompts from adults. This work was published well before genAI and “prompting” became part of the current lexicon, but the terminology now raises an additional specter beyond “ABA treats children like rats.” The phrasing also frames autistic children as statistically driven mad-lib language-generation machines that, like ChatGPT et al. can be prompted and are expected to be “Yes, and …” compliant in response.

Current landscape

The entire field of ABA seems to be wrestling with “changing practice” and attempting to leverage the idea of “naturalistic” as a cloak for past (and ongoing) sins. There also are calls for greater rigor in trial conduct and reporting, with an emphasis on overwhelmingly common sins of omission related to conflicts of interest disclosures (more below).

Then there’s the issue of the evidence base. A 2021 analysis of NDBIs (aka ABA-lite) indicated that any skills children seem to attain from the intervention only manifest in the very constrained environment in which they were forced on the children:

...these increases are largest for skills directly targeted by the intervention, and in contexts that are similar to that of the intervention.

In an analysis published in the BMJ in 2023, the authors again found that any improvements detected in social communication seemed limited to the narrow context of the intervention itself. They offer an even more powerful conclusion: that any benefits detected (1) are mainly influenced by reports from teachers and caregivers who are aware of the intervention, and (2) because of the dearth of data on adverse effects (“Researchers have inadequately monitored and reported adverse events”), no one can size up any potential benefits against these downsides. They write:

Until such information is explored by researchers, families and practitioners will continue to have little basis on which to weigh the potentially positive effects of interventions against the potential for negative impacts.

This is the kind of situation that makes informed consent impossible.

The influence of caregiver opinion on any potential positive outcomes with ABA approaches seems pervasive. A 2025 analysis found that with NDBI (ABA-lite) approaches, caregiver behavior (as guided by the model) was the primary influence on children’s social communication skills, without a direct effect of the intervention itself on those skills. Perhaps not surprising to anyone who knows anything about child development, the effective factor here was adult attention to the child’s interests and needs:

This study highlights the mediating role of caregiver behavior on the child intervention response, supporting the importance of involving caregivers as partners in the intervention for young autistic children.

What you have here is “responsive parenting,” which the ABA industry did not invent and which does not treat the parent/caregiver as a “mediator.”

Overall, the current landscape of ABA is that researchers see effects in specific targeted areas, as reported by adults in the room, and largely confined to social communication “improvements.” On this one-way street, adults aware of the intervention are going to interpret what they want to see as positive. And here’s the real deal: positive attention to a child is almost always good. The real effect here, if any, is probably from children directly gaining positive attention from their adults, no ABA techniques required.

Meanwhile, a 2025 report based on studies in Europe found no improvements in social communication in autistic children undergoing a “low-intensity” NDBI intervention. The ranges for every single outcome measure include a “no effect” value. A 2025 EU-based RCT of the Early Start Denver Model (ESDM; one standardized version of NDBI) found no greater effectiveness than treatment as usual among the 180 autistic children in the study. These authors concluded that this model “cannot be universally recommended for all young children with autism spectrum disorder.” They write:

Based on our findings, we cannot recommend adding ESDM to TAU for all children within the broad autism spectrum who are referred by community professionals to clinical centres. ESDM may not be generalisable to the entire ASD population, including children with severe autism. This raises concerns in the field of early intervention, as these children are often among the first to be identified and represent a group that we aim to support due to the severity of their condition.

A barely concealed contempt

In its position statement, ASF makes an appeal to sunk costs in a final Hail Mary effort to convince readers that ABA, especially the new! Improved! Naturalistic! ABA is great stuff for autistic children. They write that “It is a mistake to throw out an entire canon of techniques and principles based on criticism of past practices.”

They then go on to say, “Of course, we strongly are against any program or therapy that harms an individual. However, we have concluded that ABA therapy, when properly rendered in an ethical manner, is beneficial to individuals who are impacted by autism.”

It is unclear how they can conclude this when as recently as last year, researchers were still noting that adverse effects had yet to be sufficiently evaluated for cost-benefit analysis.

In an obvious sleight of hand, the ASF statement draws to its close with barely concealed contempt for autistic people who dare to push back against their stance. There is one final, disingenuous claim that the “autism community has not rejected ABA as a support for people with autism,” citing [emphasis mine]:

a recent analysis of Twitter hashtags show(ing) that over 95% of the sentiments expressed were positive or neutral, with negative tweets receiving higher engagement scores. This suggests that there is a small but vocal minority of individuals who use social media that are shaping the narrative of ABA on social media (Malkin et al., 2024).

That phrase “autism community” contains veritable multitudes, although it’s clearly meant to suggest that autistic people make up those multitudes. A look at Malkin et al indicates otherwise, as the analysis included any Twitter posts with hashtags related to ABA, including those from practitioners.

The authors ultimately included only 5408 tweets out of the 119,911 with relevant hashtags. This 4.5% of the total underwent analysis by two authors who categorized them as neutral, positive, or negative (“negative” included “promoting alternatives to ABA” – heaven forefend). The negative tweets had three-fold the engagement of the other two categories.

Their conclusion was that this “small but vocal minority … has the potential to shape the narrative on ABA.”

The implication in that line – and in the ASF’s echo of it in their statement – is that this “small but vocal minority” should be overlooked and underheard in the face of all of those neutral or positive tweets about ABA.

Never mind that the triple engagement on the small proportion of negative tweets is a far better reflection of interest on social media than a series of individuals randomly transmitting their thoughts into the ether. Never mind that the people directly and adversely affected by ABA – i.e., the autistic people – will always be a minority up against the researchers, practitioners, and caregivers who greatly outnumber them. The strong implication is that because autistic people are a minority, what they have to say should be discounted, right along with the adverse effects of ABA and any alternative approaches to supporting autistic people.

It is money all the way down

As the involvement of insurance makes clear, money is the currency of ABA. Take this 2021 review that purports to address concerns about ABA, in which the authors concluded that there is “limited to no validity” to claims that “all ABA is abuse.”

In the original version of that article, the authors state that none of them had “any conflict of interests with this commentary.” Oh, but wait. There were some, actually. Big ones that are included in a belated erratum:

It should be noted that ABA research, trainings, and services are provided by authors J. Leaf, Cihon, R. Leaf, McEachin, and Russell. Shapiro serves as board member of Autism Partenrship [sic; an ABA group] Foundation and J. Leaf. serves on several Editorial Boards, including JADD.

Yes, that definitely should have been noted.

And that’s not a one-off. These failures are strangely common in this “field.” As these authors found:

We coded included studies for COIs related to researcher employment as an ABA clinical provider or a training consultant to ABA clinical providers. We found that 84% of studies had at least one author with this type of COI, but they were only disclosed as COIs in 2% of studies. Additionally, 87% of studies with statements claiming the authors did not have COIs, were authored by researchers found to have clinical/training consultancy COIs.

And there are more.

Meanwhile, there is an ongoing flop-sweaty muppet flail to try to ensure that insurance providers recognize that the enfluffified ABA – NDBI – gets recognized as ABA so that the money continues to flow. Take this 2015 publication on which Alycia Halladay, ASF’s chief science officer, is an author. It goes to great pains to establish that interventions newly framed as NDBI are still, really, truly ABA and thus deserve insurance coverage. Indeed, the text makes it explicit: “It can be solidly argued that funding that provides coverage of ABA treatment should cover NDBIs.”

As always, you should always — always — follow the money.

News you can use

• Another way to phrase the “naturalistic” gloss on ABA is the ever-illustrative “lipstick on a pig,” applied in this context courtesy of the Therapist Neurodiversity Collective over on Instagram. They write:

  Their proposed alternative is still normalization through reinforcing alternative behaviors with rewards and punishments. In plain language, they want to expand a child’s “community of reinforcers.” That means training the child through behavior reinforcement to find different activities, interactions, and socially recognized experiences rewarding … The goal is still for the child to become less visibly and audibly Autistic and to learn that showing signs of autism is undesirable.

  Saying it again: Autistic children are not rats.

• In contrast to such efforts to manipulate autistic children through inauthentic engagement are these findings that autistic people’s own accounts characterize friendship as "meaningful, sustaining, and deeply valued," contradicting assumptions about autistic relationships as "fragile, shallow, or inherently lacking."

• ASAN has published a plain language explainer on the new Medicaid work requirements. As they note: “The rule is very bad. The rule might take away healthcare from millions of disabled people.” Read on to find out what you can do.

• From the TPGA editors: The same group of “Profound Autism” lobbyists (none of whom are autistic, many of whom are openly hateful towards autistic advocates) keep trying to make their proposed label sound official when it’s still Some Bullshit.

• If you find yourself repulsed by flatware made of wood (those ice-cream “spoons!” — shudder), you may appreciate that this article respects and reflects on the experience with different cutlery materials and how they can be taken into consideration for neurodivergent people with eating disorders.

• Julia Métraux at Mother Jones has written about the Trump administration clawback of awarded grant funds for the only research center in the USA that is focused on supports for disabled parents:

  Researchers and staff involved with Brandeis University’s National Research Center for Parents with Disabilities have learned that they will not be able to soon apply for continued federal funding, likely forcing the center’s operations to stop when current funding runs out at the end of August. Working across roughly a decade, the center has investigated laws that allow states to strip parents of custody based on disability and health disparities faced by disabled parents, and provides assistance to disabled parents who reach out for support. It is the only research center in the US focused on disabled parents.

• "We do not know much about why sensory rooms help autistic people, and [before the researchers tackled this issue] no one has asked autistic pupils about what they think about sensory rooms." Now they have asked, and here is the answer:

  Overall, pupils felt that sensory rooms supported them with wellbeing and learning, especially when they could use it in their own way.

People you should know

• SZA has announced that she is autistic. Autistic journalist Eric Garcia posted: “Oh fascinating! SZA says she got a formal autism diagnosis. This is a huge deal because Black and female #ActuallyAutistic people frequently get overlooked or go undiagnosed. Hopefully this leads to less stigma around who can be autistic.” (A TPGA editor notes that SZA uses the terms “Asperger’s” and “high functioning,” which is something people who are new to autism and disability often do.) Sara Luterman over at the 19th News covered the story.

• Nonspeaker Woody Brown in conversation with fellow nonspeaker Jason Jacoby Lee:

  The idea that disabled people are highly vulnerable to dangerous encounters with police is probably a surprise to many in the public. Who would draw a gun on a disabled person? But when law enforcement doesn’t understand the nature of your disability, there can be dire consequences.

Thanks for reading, and here’s to rooms that we can use in our own way.

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