Autisme

[Autisme] La thérapie ABA: Le pour et le contre.

Je suis une maman autiste française, qui vit aux états-Unis. Mon fils, Charlie,est autiste severe. Mon livre, All Across the Spectrum est disponible ici —> http://bit.ly/across-the-spectrum

Excusez mon français approximatif, cela fait très longtemps que je ne parle plus français régulièrement. 

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« Tu tortures ton enfant avec la thérapie ABA »

Tout comme la société en général, la communauté du monde de l’autisme n’est pas unifiée dans ses croyances à propos de l’autisme. La première fois que j’ai mentionné la thérapie ABA (Analyse appliquée du comportement) sur mon blog, il n’a fallu que quelques minutes avant que quelqu’un ne me dise: “Tu torture ton enfant avec la thérapie ABA». Cela n’a pas été une surprise. Avant même que Charlie soit diagnostiqué, j’avais cherché sur internet des options thérapeutiques et découvert que tout le monde n’aimait pas l’ABA. L’ABA est le traitement numéro un recommandé par les experts médicaux pour les enfants atteints d’autisme, malgré cela de nombreux autistes rejettent cette conclusion. En tant qu’adulte autiste, je vois les deux côtés du débat, mais dans l’ensemble, je suis en faveur de la thérapie ABA.

La thérapie ABA avant et maintenant

Je pense qu’un peu de contexte est nécessaire ici. La thérapie ABA a énormément évolué au fil des ans. Ce n’est pas la même chose qu’il ya 60 ans lorsque le Dr O. Ivar Lovaas a conçu les premières applications de l’ABA pour aider les personnes autistes. Il l’a fait sur la base des principes développés par le célèbre psychologue B.F. Skinner, trouvés dans son livre, publié en 1938, The Behavior of Organisms. À l’époque, ils utilisaient la répétition robotique des essais d’apprentissage, dans des salles stériles et administraient des sanctions pour aider les personnes autistes à acquérir des compétences nouvelles et appropriées. A cette époque, les récompenses et les punitions étaient utilisées de manière égale. Plus tard, il est apparu clairement que les récompenses marchaient mieux que les punitions, et que les punitions, même si elles auraient pu encourager l’apprentissage pour certains, ont également engendrées la peur. Les méthodes utilisées aujourd’hui pour aider les personnes atteintes d’autisme ont tellement changé depuis les premières expériences de Lovaas: il est même injuste qu’elles portent le même nom.

Thérapie ABA basée sur le jeu

La thérapie ABA de Charlie est basée sur le jeu. Il n’y a pas de punition. Bien sur, les thérapeutes peuvent donner une conséquence à Charlie en lui enlevant un jouet s’il les frappe quelqu’un ou crie, mais la plupart des parents le font avec leurs enfants, qu’ils soient autistes ou non.

L’ABA n’est pas «une solution pour tous» et un bon BCBA s’efforcera de développer le meilleur programme pour un enfant. Par exemple, nous voulions que Charlie acquière plus d’indépendance. Notre BCBA a donc conçu un programme pour lui apprendre à se brosser les dents et un autre pour lui apprendre à s’habiller tout seul. Il n’y aura pas de punition s’il ne peut pas le faire, mais s’il le fait, il obtiendra une récompense, Certaines semaines, cela pourrait être son iPad. D’autres semaines, il pourrait s’agir d’une cuillère de Nutella ou d’un biscuit.

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La thérapie ABA et le capacitisme

La plus grande critique à propos de la thérapie ABA est le capacitisme (ableism en anglais), la discrimination en faveur des personnes valides. Je ne suis pas d’accord pour dire que la thérapie ABA est capacitante. Vous pouvez aider quelqu’un sans changer qui il est. Charlie n’est pas en ABA parce que nous voulons qu’il soit normal. Nous voulons qu’il soit en sécurité, indépendant et qu’il apprenne à communiquer, à diminuer sa frustration (et oui,la notre aussi). Nous voulons éliminer les comportements moins fonctionnels et dangereux, comme jouer avec la litière du chat, avaler des pierres et courir dans la rue, pour lui donner les meilleures chances de réussir dans la vie. Je ne cherche pas à «réparer» Charlie.

La thérapie est là pour lui faciliter la vie en lui fournissant des moyens de communiquer et, surtout, le protéger. S’il faut donner un cookie a Charlie pour lui faire cesser ses comportements dangereux et qu’il apprenne à prendre soin de lui, et à communiquer, cela me convient tout à fait.

ABA et les histoires d’horreur

Toutes les personnes qui travaillent avec Charlie sont géniales. Mais, tous les BCBA, thérapeutes et centres de thérapie ne sont pas parfaits. Certains centres sont mal dirigés et les méthodes utilisées sont imprécises et abusives. Bien que cela devienne de moins en moins courant, cela peut expliquer les histoires d’horreur que vous lisez sur internet. Il est important que les parents choisissent un centre ABA qui correspond à leurs valeurs, un lieu où les thérapeutes et les BCBA les écoutent s’ils ont des préoccupations sur la façon dont une compétence spécifique est enseignée.

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La thérapie ABA et le stimming

D’un autre côté, il y a une partie de moi qui voit comment l’ABA peut parfois être nocive pour les autistes. Par exemple, certains thérapeutes ABA peuvent empêcher un enfant de battre des mains (flapping) ou de se balancer. Pour moi, il n’y a rien de mal with stimming tant que cela ne gêne pas l’apprentissage. À l’école, j’espère que les enseignants apprendront aux autres élèves ce que cela signifie, au lieu d’essayer d’empêcher Charlie de stim parce que les autres enfants ne comprennent pas.

Mais bon, un stimming constant peut empêcher un enfant de se concentrer en classe. Je ne pense pas que nous, les autistes, devrions changer pour nous adapter aux personnes neurotypiques, mais je veux aussi que Charlie ait toutes les chances possibles pour qu’il puisse éventuellement apprendre, et peut-être que cela signifie l’empêcher de stim dans certaines situations . L’équilibre entre vouloir que les gens acceptent les comportements non-nuisibles que les autistes adoptent souvent et vouloir que Charlie soit accepté, et capable de se concentrer dans des situations de la vie réelle, est parfois difficile à trouver.

Oui à la thérapie ABA mais avec certaines conditions

La thérapie ABA a été d’une grande aide pour Charlie et pour nous, ses parents. Cela m’attriste à quel point on accorde peu d’importance aux parents d’enfants autistes. Ca m’écoeure lorsque les gens me disent que je torture Charlie avec l’ABA et que cela n’a aucune importance que Charlie apprenne à communiquer et à développer des compétences en matière de soins personnels, car ce qui compte, c’est qu’il soit heureux. Charlie est parfaitement heureux quand il joue dans la litière du chat. Charlie est content quand il se cogne la tête contre le mur. Charlie est content quand il court dans la rue devant les voitures…

Qu’en est-il de la sécurité de Charlie? Qu’en est-il de moi en tant que mère? Dois-je laisser mon enfant se mettre en danger parce qu’il est heureux? Charlie est malheureux quand il ne peut pas communiquer et se faire entendre. Grâce à ses thérapeutes ABA, Charlie peut maintenant communiquer des besoins de base (genre “je veux de l’eau)  avec une application sur son iPad, appelée ProloQuo2go.

J’étais désemparée avant que la thérapie ABA entre dans notre vie. Je n’aurai pas pu accomplir ce que les thérapeutes de Charlie ont fait pour lui, par moi-même. Un enfant autiste grandit dans un monde composé presque entièrement de personnes neurotypiques et doit apprendre à fonctionner en son sein. L’objectif ultime de l’ABA est d’aider les personnes autistes à vivre une vie indépendante, safe et heureuse dans ce monde – et je pense que c’est merveilleux. Bien que je comprenne certaines des inquiétudes suscitées par l’ABA, j’estime que l’ABA administrée par des personnes attentives, ouvertes à la critique et soucieuses de l’intérêt supérieur de l’enfant est la meilleur thérapie pour des enfants autistes.

 

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24 Comments

  • Reply
    André
    2019-03-16 at 3:16

    Removing loved things from the child to make them earn it as an reward is abusive and makes the child lose intrinsic motivation and stop sharing what they like

    • Reply
      Andreea
      2019-03-20 at 5:16

      And you’ve walked how many miles in these parents’ shoes? Abusive is when you cause intentional harm, professional therapy for a child who needs to learn certain skills, skills that he does not have the ability to develop on his own unlike many of us, is not abusive. It may be unpleasant, but then again so is time out (for any child).

      • Reply
        Marco
        2019-06-24 at 2:03

        I walked in the child’s shoes. I am now 56 and a university professor. I’s abuse plain and simple.

    • Reply
      Katherine
      2019-05-18 at 4:45

      Removing things is literally what every parent does.

  • Reply
    Nikki
    2019-03-21 at 4:10

    As a pediatric PT, I can tell you what you are doing is not abusive. Good for you and good for Charlie for working toward greater independence and less frustrations! It takes a lot of work and dedication and selflessness on your part to commit to this much therapy. Pat yourself on the back.

  • Reply
    Jessica W
    2019-03-21 at 12:35

    Mama, you are amazing. You are so inspiring. You are a wonderful mom to your boys.

  • Reply
    Sonia
    2019-03-21 at 4:25

    I am an autistic mom with kids on the spectrum. Ans i believe ABA fo e well CAN and DOES help the child. Good job mama

  • Reply
    Jen Phillips
    2019-04-28 at 5:43

    Intensive repetitive forced behaviour all for a bite of cookie is abusive. It may not seem that way to some especially because it is effective at altering behaviour. Yes it can help to change behaviour that is dangerous but there are also other less intensive or repetitive methods that can do this. Research is beginning to emerge that shows how ABA and behaviour therapies damage mental health in the long term. If you can access it here are the references: Gardner, F., (2017). First-Hand Perspectives on Behavioral Interventions for Autistic People and People with other Developmental Disabilities.
    Milton, D., & Moon, L. (2012a). The normalisation agenda and the psycho-emotional disablement of autistic people. Autonomy, the Critical Journal of Interdisciplinary Autism Studies, 1(1).
    Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism, 4(1), 19–29.

    • Reply
      David N. Andrews M. Ed., C. P. S. E.
      2019-06-26 at 5:14

      Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism, 4(1), 19–29.

      That paper is an absolute embarrassment to any autistic adult who wants to get taken seriously in science. I say that as an autistic adult who wants to get taken seriously in science. I also say it as an autistic psychologist who taught research methods and data analysis at postgraduate level for two years at his alma mater.

      There was NO clinical verification of any diagnosis of either autism or PTSD. There was no definition given of what ABA actually is, and nor was there a description of what was being done in any intervention being given to autistic people taking part in the ‘study’ – this makes it impossible to differentiate between ABA, per the definition given by the BACB, and anything being ffered under the name of ABA but not fitting the definition. I don’t remember reading about a control group of any sort.

      Had she been my student, I would have failed that paper. For a master’s graduate, I expect master’s level performance. That was not a master’s level paper.

      • Reply
        Keisha B
        2019-07-18 at 9:06

        This is because she’s not a scientist. She has a music degree and a « Master of Arts in Transformative Leadership ».

        She claims to be a doctoral student but both schools I’ve seen listed for her are unaccredited diploma mills which I assume she chose because they would also her to claim « doctoral research » for poorly-conducted studies supporting her own biases and agenda without the right or oversight of a real college.

      • Reply
        Danielle
        2019-09-29 at 2:46

        The thing that’s just so unfortunate is there is not enough research about the long-term effects of ABA- positive or negative. I hope at least that this article encourages more and improved research on related topics.

  • Reply
    Jen Phillips
    2019-04-28 at 5:45

    Also I forgot to mention that there is a strong evidence-base in the research related to mental health and intrinsic/extrinsic values that can be used to argue against reward based systems too. In a nutshell: teaching children to do something for a reward teaches them that what is important is doing things for the rewards (extrinsic gains). The research surrounding mental health has shown that when a person’s choices in life are weighted more towards doing things to gain extrinsic rewards their mental health suffers. These people are more likely to undertake tasks that they often hate just so that they can gain the reward and this pattern continues throughout their life i.e. they might end up chasing high flying careers just for the large wage that comes with that so they can buy the big house, nice car etc., rather than the fact that they love the job, therefore they make themselves miserable but they don’t realise that the things they are chasing won’t make them happy. This is because the reward satisfies briefly but it is fleeting happiness and it is not self full-filling, Some people might also develop problems with addiction too, because they feel they have to constantly reward themselves. They might become addicted to shopping, smoking, alcohol, drugs, food etc. Reward systems for young impressionable minds, whether autistic or not, are not good for mental health in the long run.

    • Reply
      Meg
      2020-01-08 at 5:20

      There is a strategy in aba called fading. We fading and pairing. Ultimately we program so that client will be naturally reinforced. An awesome bcba will also program for generative learning… teach cognitive flexibility.

  • Reply
    connie edwards
    2019-06-27 at 12:37

    when i was a kid my mum wanted me to learn to love books; she would put aside half an hour of an evening, turn the lights down low and make reading « a special time ». we would cuddle and enjoy reading together. my brother and i have been avid readers all our lives. THIS IS ABA. people forget that the principles of aba are 99% common sense; they are the things that we do as parents/carers all day, every day. ABA principles are utilised in every intervention that works. let’s not vilify a science because of a whole lot of pre-conceived ideals. conversely, let’s accept that there have been lots of wrongs that have been performed in the name of aba but that we need to spend more time talking with open minds about what we want to achieve and how we are going to do that…

  • Reply
    Suzie
    2019-06-29 at 12:01

    Thank you for writing this 🙂 all the best. I hope many other parents find it helpful, positive and objective.

  • Reply
    Becky
    2019-07-09 at 7:12

    ABA therapy saved my son. We started at 18 months and continued until he was 3 and he is currently 9 and THRIVING. Happy as a clam, able to function beautifully in society, has friends…is an all around different kid. If that’s abuse then call me the biggest abuser on earth because I’m so thrilled with all it’s done for him.

  • Reply
    Joanne P
    2019-07-19 at 3:15

    I live in the UK and we don’t really have ABA here. Our health service exists to support people not make money for « therapists » who insist the child NEEDS 40 hours a week of their expensive services!

    My son is currently learning his life skills such as getting himself dressed. I lay the clothes out the right way round and he puts them on. Once he is dressed he can either carry on playing or we go out, whatever we’ve planned for the day. There is absolutely no need for an extrinsic reward like a cookie (aside from the issues around sugar defeating the teeth cleaning lessons LOL). We need to promote intrinsic motivation to help him later in life.
    Same with learning to use his AAC – he also uses ProLoQuo2Go but the reward is getting us to understand his wants and needs, not getting a cookie for doing so.

    All the other things the author describes can be learned without ABA. Thousands of British children have done this for many years, I chose the two examples as they resonate with the life stage we are currently at.

    My final question is always the same – if ABA is so different now, then why use a name which actually affects autistic adults with PTSD so badly that the very acronym is banned in many support groups?

    • Reply
      Marsha
      2020-01-08 at 5:25

      Hmmm.. so he puts his clothing on and he gets to do something fun! You have positively reinforced him, which means u have increased his behavior getting dressed in the future. Essentially u provided him the motivation to learn to dress himself. Aba is everywhere

  • Reply
    Angelica
    2019-07-25 at 1:18

    I would strongly recommend that any parent considering ABA for their child makes sure to ask a very important set of questions of the BCBAs:

    – A UN Special Rapporteur on Torture says what is done at the Judge Rotenberg Center is, in fact, torture. The BACB has not stripped the credentials of the BCBAs involved in using shock devices as aversives, and will not, as it is not against BACB ethical guidelines. Are the ethical guidelines at your facility different from the BACB’s? If so, in what ways? (If no, run. Run like hell. Ethical guidelines that allow torture are insufficient to protect your child.)
    – Have you lobbied the BACB to get more stringent ethical guidelines so that children are protected from harmful practices like those currently in use at the Judge Rotenberg Center? If not, will you do so? Will you encourage fellow BCBAs to do so?
    – Have you boycotted ABAI conferences that include the Judge Rotenberg Center as a speaker, and have you lobbied for the Judge Rotenberg Center to no longer be included as a speaker? If not, will you do so in the future?
    – BACB ethical guidelines do not require that my child’s needs are put above my own. We are both defined as the « client », and no prioritization is given to the needs of the one receiving services over the needs of any other person defined as a client in that document. What guarantees do I have that you will ALWAYS put my child’s needs above my own, seeing as the ethical guidelines of your profession don’t require you to do this?
    – Do you agree with the use of physical punishments and physical aversives, which are permitted under BACB ethical guidelines? (If yes, run. For your child’s safety, run.) If no, have you lobbied the BACB to remove their inclusion among things considered ethical by your profession? If you have not in the past, will you begin now?

    No facility (or person) that condones or excuses torture like that at the Judge Rotenberg Center is safe for your child to be near. No ethical guidelines that permit torture are stringent enough to keep your child safe. A person who isn’t willing to speak out against a member of their profession committing torture cannot be relied upon to tell you if it’s happening to your child. If you’re going to consider ABA, please, PLEASE ask these questions. Keep your child safe.

    Further reading/viewing for context:
    BACB Ethical Guidelines for BCBAs: https://www.bacb.com/wp-content/uploads/BACB-Compliance-Code-english_190318.pdf
    Judge Rotenberg Center Torture Compilation by former JRC Staff (video): https://www.youtube.com/watch?v=Ko-ip3MImik [It’s long and hard to watch at times. Watch the whole thing. It’s from 2012, but JRC is still using GEDs today.]
    How the ABA Industry Endorses the Use of Electric Shock Devices on Autistics: http://autisticbride.co.uk/2019/05/24/how-the-aba-industry-supports-the-use-of-electric-shock-devices-on-autistics/

    • Reply
      Marsha
      2020-01-08 at 5:27

      Please read the bcba ethics. Punishment is unethical. A Bcba must use reinforcement procedures… punishment can only be used under specific circumstances.

  • Reply
    Charles Teague
    2019-09-20 at 2:48

    Just got the book. My wife and I are so impressed! Full of beauty and insight, worth pondering like few books you will ever have the opportunity to read. :^)

  • Reply
    Behaviour Analyst
    2020-01-24 at 7:18

    I find it so frustrating and upsetting that some people ‘blanket policy ABA as abusive’. I’m a Behaviour Analyst. I am NOT abusive! I absolutely love, respect and care about the children that I am lucky enough to support. The ABA therapy that I see delivered, focus’ on fun and learning through play. It looks at helping a child to learn important skills. Where possibly intrinsic reinforcement is used (if it’s there then you use it).. for some though we don’t always have that luxury. Then we look at positive reinforcement that can be used to help motivate until the intrinsic reinforcement comes. This therapy that I see day in and day out prevents children from having more teeth removed because they now feel ok about teeth brushing and accessing the dentist, allows a child to feel ok about having a medical assessment without heightened anxiety and gut wrenching parental or hospital staff restraint. It has helped children to stay IN THE FAMILY HOME when the support network was struggling to cope with severe challenging behaviour and risk to siblings. This BLOODY AWFUL therapy has given children a voice AGAIN and AGAIN so that those children without communication can advocate for themselves. They can tell people to back off, to give something back, that they are IN PAIN!!! I have watched children struggling to make friends. Sat on the periphery with no way of navigating the complex dynamic of social interaction. I have watched the same children make friends, join in with playground games and feel happier and more content.

    The children that I see are hi-5ing me (through intrinsic reinforcement) as I walk through the door. I get hugs, fist pumps and the odd fist in the air accompanied by a ‘YES X is here – what a treat’ (quote verbatim). That’s because this therapy that is so TERRIBLE can he delivered with incredible kindness and compassion, where best interest and a child centred approach is at the heart of every decision.

    I appreciate that not all ABA is good. BAD ABA and these professionals need to be held accountable!!! However a well rounded account of criticism might also want to focus on the TYPES of special schools that sing about the weather every bloody morning, play skittles every Tuesday for four years and do the same mundane jigsaws over and over again. The types of places that don’t realise that I child can actually SPEAK after being in a provision for 2 whole years. It might want to look at treatment and assessment units – the type of ones that once you are in you don’t come back out! I spent a proportion of my career trying to help adults come out of places like this and to live a life of value – their own VALUES, safety and CHOICE!

    The ABA bashing sometimes gets me down but then I go back to my reality and to what I KNOW, with the children that I care about and then I know I am trying my best to do the ‘right thing’ to help a child to learn skills that will enrich their quality of life, better advocate for themselves so they are less vulnerable, to safeguard their health and just as importantly mental health by working on self esteem and confidence when developing social skills. I watch those children laughing their heads off through the session, reaching out to their therapists to initiate more interaction and to prolong play.

  • Reply
    Becky
    2020-01-25 at 11:17

    Hi there! I found your article very insightful and well-balanced and close to the conclusion I had come to already. My one question that still lingered, is one you touched on, but didn’t really elaborate on, which is in regards to stimming. As a parent, I have no desire to stop him from stimming and I would for the most part, object to any objective to make it so. Keeping him in mind though, while it is important to me that he is happy with himself however he may be, I think its important that he becomes aware of others and being mindful of others feelings. I have a feeling if I presented this question to adult autistics in general, it would be met with a backlash of « what about us? What about our feelings? » But it’s a legitimate question… For context, I am likely an undiagnosed autistic raising an autistic son, so I say this with utmost respect, but his stimming can sometimes be incredibly distracting, disruptive, and irritating to others. In many settings, I can see how this would be a big hurdle for others, such as focus in a classroom. For instance… I dont want to raise my son to think, that if he can help it, he should just stim away, because he is neurodiverse and everyone should accept it. I’d like him to be able to acknowledge that certain types of stimming could be disrespectful in certain settings because it’s not being mindful and considerate of others. Do you feel this is unreasonable? I want to do the best by and for my son. I want him to be comfortable being exactly who he is, but also not to believe the world revolves around him. I’d love to know your thoughts.

    • Reply
      RBT
      2020-02-21 at 11:36

      Hi Becky,
      I am a registered behavior technician in route to becoming a BCBA/LBA. I spend too much time getting sucked into click-hole articles about the controversy surrounding ABA, but this is the first time I’m replying or engaging with anyone (on the internet) in regards to the topic. Trying to reduce stimming that causes no harm to the individual doing the stimming has always raised ethical concerns for me. I will use vocal stereotypy (i.e., non-contextual utterances that vary from snorting and grunting, to repetitive phrases unrelated to the present situation) and hand flapping as examples. Assuming that the vocal stereotypy isn’t of high volume, like screaming or screeching, it’s likely to not be harming those around the individual either. So if a learner snorts and it serves some sensory-satisfying function that causes no harm, why is the behavior trying to be reduced? Under the same assumptions, I ask the same question in regards to hand flapping. The way I have seen most of these behaviors addressed is only in the context of learning–a person cannot pick up a pencil and write if their hands are flapping; a person cannot functionally communicate if they’re engaging in vocal stereotypy, etc. So, when goals such as functional communication and tracing/writing letters are being worked on, these stims are « competing » with responses that the goals are targeting. It’s during these times that I have interrupted stimming and redirected the learner to whatever it is we’re working on. When new, socially significant behavior is not actively being taught (when the learner is on break or has free time during a session) they are free to stim. I see this as an ethical implementation of aba techniques. But as you mentioned, stimming can be disruptive to those around the individual. So great, the learner has learned to not flap their hands during « structured » portions of an aba session…but what about at the grocery store? In the movie theater? And if stimming is interrupted or attempted to be quieted in community settings are we then just trying to make them appear like a neurotypical person? Of course this not my, nor most aba professional’s, goal, but I understand why people are likely to assume such an intention. Just like how stimming can interfere with learning during an aba session, it can compete with opportunities to socialize, navigate, and functionally interact out in the community. Sometimes these behaviors keep parents and caregivers from taking their loved ones into the community, period. They may be embarrassed (which is as upsetting to me as it is to anyone else), or they can foresee their child’s stimming being disruptive to those around them. They may want to take their child to the movie’s but the last time they did, other patrons couldn’t pay attention the movie, rude comments were made, etc. In regards to others accepting these behaviors because the person is neurodiverse…I mean I think our culture/society is becoming more aware of neurodiversity and how it presents itself, but the reality is that talking to oneself, rocking back and forth, flapping ones hands will continue to draw people’s attention; these behaviors can cause disruptions and severely limit the opportunities an individual has. Sorry, I feel like I’m talking in circles here. Point being, stimming during times and in environments that impede one’s ability to learn, socialize, and/or perform a functional task is something that needs to be looked at closely. We all learn what things are « acceptable » public behavior–I bite my nails, especially when anxious, but I have learned from aversive social interactions that people find it pretty gross. For the sake of my own dignity, I don’t bite my nails in public. Should people not be grossed out by this because I have an anxiety disorder? I would certainly like think people might be sympathetic, but I wouldn’t expect someone to shake my hand right after my fingers were in my mouth. I know, that’s not a perfect comparison, though I hope the point I’m trying to make still translates. I still struggle with when and how often (if at all) self-stimulating behaviors should be targeted as behavior-reduction goals. Each individual and each behavior needs to be assessed on a case-by-case basis. Luckily I worked with a team of BCBAs that are receptive to feedback, suggestion, and any questions–ethical or otherwise–that someone else poses. If you’ve made it through this jumble of thoughts (there’s more I want to blab about but I worry I’m not articulating myself well enough as it is, haha) thank you for indulging me.

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