Does ABA cause PTSD?
The answer is no, ABA Therapy does not cause PTSD. One of my followers explained where the rumor originated from. There was only one survey about the subject and it was published in a pay-to-publish journal.
The idea that ABA causes post-traumatic stress disorder (PTSD) stems from one online survey that was circulated amongst social media groups (Kupferstein, 2018). The survey included 217 respondents who were caregivers of children with autism and 243 respondents who were adults (18-73 years of age). The adult respondents identified themselves as autistic, with or without a clinical diagnosis of autism; their average age at the time of their autism identification was over 25 years of age. The survey included questions about post-traumatic stress symptoms (PTSS); it did not ask for an independently verified confirmation of a diagnosis of PTSD. The survey also did not define ABA-based interventions, apart from stating that these were “early interventions”.
In addition, no actual numbers are reported in the paper, just the percentage of respondents. A quick calculation illustrates a problem. Given that the non-completion rate of the survey was high (only 50% of adult respondents and 61% of caregivers answered all of the survey questions), this means that only about 120 adults with autism and about 130 caregivers completed the survey fully. Of the adult respondents, 11% are reported to have experienced ABA-based interventions, which means that only 11 or 12 adult respondents had experienced some kind of ABA-based interventions.
As mentioned above, though, there are inconsistencies because ABA-based interventions purportedly were experienced in early childhood, but autism was not diagnosed until these adults were over 25 years of age. It is very unlikely that someone would have been given early ABA-based autism interventions unless they were diagnosed with autism at an early age. In any case, of the adult respondents who said that they had experienced ABA-based interventions, 62% reported some PTS symptoms. In other words, this appears to apply to a total of 6 or 7 adult respondents to the survey, clearly not enough to draw definitive causative conclusions about a whole population or a science.
Apart from drawing on very low numbers and unconfirmed diagnoses, there is no mention in the paper of any additional or multiple traumatic life-events during adulthood, such as bereavement, abuse, accidents, or near-death experiences, that have been linked to post-traumatic symptoms (Grabrucker, 2013; Sharain et al., 2009). Furthermore, Kupferstein also asserts that mothers who were exposed to childhood trauma, including physical, emotional, or sexual abuse are nearly twice as likely to give birth to a child with autism. Recognition that childhood trauma may be caused by parental trauma is evidenced in research related to transgenerational transmission of parental trauma and/or trauma-affected parenting (Fargas & Dillenburger, 2016).
Kupferstein (2018) compromises her own conclusions with the statement that “[a]utistic people have a sensitivity to the way any situation is initially appraised, and a benign situation which was perceived as harmful or threatening to the individual can become a PTE [potentially traumatic event] which could trigger PTSS due to their underlying vulnerability” (p.20). Clearly, then, even if these adults experienced helpful and “benign” interventions, the vulnerability, sensitivity, and sensory over-selectivity that is part of the diagnosis (APA, 2013) could have led to PTS symptoms.
There are many other severe methodological problems with this study that were exposed some time ago and for these reasons, the study itself has been discredited. “Kupferstein’s results should be viewed with extreme caution due to several methodological and conceptual flaws including, but not limited to, leading questions used within a non-validated survey, failure to confirm the diagnosis, and incomplete description of interventions.” (Leaf, Ross, Cihon, & Weiss, 2018, p122). Yet, the myth that interventions that are based on the scientific application of behavioral principles cause PTSD remains and is cited frequently in tribunals. In reality, there is much more evidence that people with a confirmed diagnosis of PTSD seek and are supported by effective and evidence-based behavior analytic procedures, such as behavioral activation, graded exposure (Gros et al., 2012), and cognitive behavior therapy (NICE, 2017).
ABA Therapy does not cause PTSD or trauma.
ABA therapy is not abusive. It’s not ableist, nor is it conversion therapy, either.
Our autistic children don’t do ABA therapy from some misplaced parental desire to make them “normal”, and nor is it to eliminate their autism. They’re in therapy because they need to learn the essential skills to keep them safe, happy, and independent, and to not make an earnest attempt at this would be wrong.
Our children are in therapy to learn that running in front of cars is dangerous. So they can learn to communicate, through their own voice or through the speakers on a tablet. So they can get dressed by themselves. To tolerate eating the foods they need to be healthy. And to use the bathroom in a sanitary and dignified way of which everyone is worthy.
Autism is a broad spectrum, so while many higher-functioning autistics can navigate society without much help, there are many others, like my son, who need substantial support for the most basic everyday functions. In addition to lovingly helping them, to — in the name of neurodiversity — not help them learn to help themselves would be nothing short of negligent and cruel.
I’m not ready to accept that almost all of Charlie’s thoughts and feelings may forever be trapped lonely in his mind, frustrating him and isolating him from the world. A translation could exist — therapy for Charlie means professionals working full-time to access it.
I’m not ready to accept that he’ll never have a sense of danger, that every moment of his life outside the home will require holding hands.
And I am not ready to accept that Charlie may never be independent enough to use the bathroom with the dignity befitting any and all humans.
So, until there’s not an ounce of hope left in me — until forever — our family will work with Charlie to work *for* Charlie, whether that’s ABA therapy or whichever type of help will help.
If in your eyes, that makes me an abusive mother, I don’t need to know what a good mom is.
You can read my balanced view on ABA therapy as an autistic adult here.