Exposing Violence in ABA With Ciara Harte

Ciara Harte is a neurodivergent counsellor based in Victoria, British Columbia. In this episode, Kristen and Ciara chat about Ciara's critical discourse analysis of ABA. Ciara has firsthand experience working with applied behaviour analysis principles and practices, and was heavily involved in ABA for a few years. 

Topics discussed also include:

• A brief history of ABA
• The interactional and discursive view of violence and resistance + response-based practice
• The problem of informed consent and ABA
• The ways autistic children enact resistance during applied behaviour analysis

If you'd like to know more about topics discussed in this episode, check out:

"Reframing Compliance: Exposing Violence Within Applied Behaviour Analysis" by Ciara Harte

Check out Ciara's website: Ciara Harte Counselling

"Autistic Experiences of Applied Behaviour Analysis" by Laura Anderson

"Quiet Hands" by Julia Bascom

Handbook of Applied Behavior Analysis: History, Philosophy, Principles, and Basic Methods by Wayne W. Fisher et al.

"The Line Between Intervention and Abuse: Autism and Applied Behaviour Analysis" by Patrick Kirkham

"Evidence of Increased PTSD Symptoms in Autistics Exposed to Applied Behavior Analysis" by Henny Kupferstein

"Invisible Abuse: ABA and the Things Only Autistic People Can See" by C. L. Lynch

"I Am a Disillusioned BCBA: Autistics Are Right About ABA" by Jo Ram

"Publication Bias in Studies of an Applied Behavior-Analytic Intervention: An Initial Analysis" by Elyssa Sham and Tristram Smith

Episode intro and outro music: "London 2 Catalan" by Independent Music Licensing Collective (IMLC) (no changes or modifications were made) 

All episodes written and produced by Kristen Hovet.

Send in your questions to otherautism@gmail.com

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The views, opinions, and experiences shared by guests on this podcast are their own and do not necessarily reflect those of the host or production team. The content is intended for informational purposes only and should not be taken as medical or professional advice. Please consult with a qualified healthcare provider before making any decisions related to your health, fitness, or wellness. 

Transcript

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Kristen Hovet  
Today I'm speaking with Ciara Harte, a counselor based in Victoria, British Columbia, Canada. I found her thesis paper when I was looking to find out more about applied behavior analysis or ABA. Her paper is called reframing compliance, exposing violence within applied behavior analysis. And I was drawn to it because of Ciara's unique analysis of ABA. I'll let Ciara explain her analysis and findings soon. And if you're interested in reading her paper, I've added the link in the show notes. Before I go any further, I'd love for you to consider your position on ABA. Because I know listeners are going to be probably one side or the other. Probably pretty strongly anti ABA, or pretty strongly pro ABA. A lot of you might not have heard of it. That's okay, too. I really want you to think about it. Bring it into your mind. If you do have a position, bring it into your mind and envision it almost like it's in front of you. What influenced your position and what helps maintain it? Would you consider your position relatively flexible or set in stone? Again, if you don't have a position on ABA, if you've never even heard about ABA, that's totally okay. I'll define it and Ciara will go into some interesting details on the analysis she conducted. Okay, let's go.

Kristen Hovet  
I want to start by defining what Ciara means by violence, as it's different from what we might think of first when we think of violence. I don't know about you, but when I hear the word violence, I think of physical violence and physical injury resulting from interpersonal conflict. The violence we're talking about here can include physical violence, but it can also include more subtle or invisible forms of violent acts perpetrated by one person against another. In a follow up email, Ciara provided this definition of violence. Violence is social, and unilateral. Violent behavior is social in that it occurs in specific interactions comprising at least two people. And it's unilateral in that it entails actions by one individual against the will and wellbeing of another. Violence is not a mutual action. Secondly, violence is deliberate. The perpetrators of violence anticipate resistance from victims and take specific steps to suppress and conceal it. Virtually all forms of violence and systems of oppression entail strategies designed for the suppression of both overt and covert resistance. 

Kristen Hovet  
Now I'm going to give a definition and a bit of background about ABA. Ciara also goes into some of this later on. Applied Behavior Analysis, ABA, is the gold standard intervention for autistic children that comprises a home based and or school based protocol, typically lasting 20 to 40 hours a week for two or more years. ABA is championed by some of the world's leading autism charities and organizations, has dominated the autism therapy space since the 1960s, and has increasingly come under fire for causing irreversible and or serious psychological harm to autistic individuals, harm that might not be obvious until they reach adulthood. With a growing body of research highlighting the lived experiences of autistic individuals and former ABA therapists, I think the time has come to question the primacy and authority of ABA and its proponents. 

Kristen Hovet  
While the old medical model portrays autism as a pathology in need of fixing, the newer social model, inspired by the latest autism scholarship and the neurodiversity movement, defines autism as a developmental variation in human cognition or neurological makeup that does not require treatment, elimination, or cure. My preferred model is the social one, though you'll hear remnants of the medical model in terminology such as diagnosis and assessment. By the way, I did an episode this season on the medical versus the social models of autism. So be sure to have a listen if you haven't already. 

Kristen Hovet  
As Ciara mentioned during our conversation, ABA is grounded in the medical model of autism, through and through. ABA was developed as an autism therapy in the 1960s following application of behaviorism in the treatment of mental health conditions throughout the 1950s. Ole Ivar Lovaas is the most well known ABA focused psychologist who's often credited with popularizing the therapy. Some call him the father of ABA. ABA comprises a set of practices and procedures based on the behaviorist concepts of operant conditioning, reinforcements, and punishments where an individual is rewarded with snacks or a favorite activity or toy for exhibiting a desirable behavior or punished for exhibiting an unwanted or undesirable behavior. Punishments in ABA have historically included electric shock, spankings, beatings, withholding food, physical restraints, timeouts, yelling, public humiliation, isolation rooms, and comfort or attachment objects being taken away. While electric shock and beatings as punishments mostly ended in the 1970s and 1980s, a minority of institutions and practitioners still reportedly use these so called physical aversives. Physical restraint in the form of holding a child's arms or hands down, or even velcroing a child's hands together continues to be used by some ABA practitioners. If you do some reading on Google about ABA, you'll notice that it's often referred to as an evidence based intervention, or even as the only evidence based intervention for autism. However, non ABA affiliated clinicians and researchers have not been able to replicate Lovaas's results showing a ABA's effectiveness or his claims that ABA cures autism in half of all autistic children. And randomized controlled trials or RCTs have not been conducted on ABA, since it would be unethical to withhold an intervention that is considered gold standard and evidence based from participants in an RCT. 

Kristen Hovet  
In addition to being irreplicable, research in support of ABA has come under fire for being heavily biased, burdened by excessive financial conflicts of interest, and poorly constructed. And a growing body of research suggests that ABA leads to harmful outcomes in many autistic people who went through the intervention as children. These harmful outcomes include lifelong struggles with post traumatic stress disorder, chronic inability to self soothe, self loathing, depression, increased suicidality, learned helplessness, and lack of appropriate boundary formation or enforcement between self and others. Relatively recent qualitative research has been inspired by articles and essays written by former ABA therapists and concerned citizens documenting the trauma they or their loved ones experienced in ABA as children. ABA is an important intervention to examine closely since it remains the most commonly recommended intervention for autistic children in North America. The alarmingly high numbers of accounts regarding negative long lasting consequences of ABA, as well as the failure of ABA organizations and practitioners to adequately address these complaints, make ABA an important focus for critique. There are many alternatives to ABA, such as occupational therapy, which could be brought to the forefront as first line or gold standard interventions for autistic children, should they choose. Now, I'm honored to introduce you to my guest for this week, Ciara Harte. 

Ciara Harte  
My name is Ciara. I'm a registered clinical counselor in British Columbia. And I think the first thing to note is that I'm neurodivergent myself. I'm an ADHDer and I work with lots of neurodivergent people about topics like internalized ableism and the process of unmasking. My connection to this particular topic around ABA started while I was in my undergrad degree. I have a Bachelor's of Child and Youth Care and a Master's of Counseling. But when I was in my bachelor's degree, my first introduction to APA was that I did a practicum at a center here that does ABA. And for a few years after that I worked for a handful of different agencies that work with autistic youth amongst other neurodivergent youth. And part of that did include being trained in aspects of ABA, being asked to implement some of that, which I did. And I've seen others use ABA in their work with kids. I'm not in that world as much anymore these days, but for a handful of years, I was really in it and seeing it firsthand.

Kristen Hovet  
What inspired you to write your thesis on violence in ABA?

Ciara Harte  
There were a couple of reasons, I'd say. The first thing is that I'm a writer at heart. And I'm really interested in language, and how we use language in lots of different ways. The next thing, like I was mentioning, I spent a lot of time working with autistic and other neurodivergent kids and youth. When I was in grad school, I started to learn about this framework called response based practice, which is the lens that is underneath, and the inspiration for the framework that I use to analyze the studies in my thesis, but really, at the base of it all, in response based practice, it's based on the principle that when people are experiencing violence or oppression, they will resist that violence in ways that uphold their sense of safety, agency, and dignity. And in what I was reading and learning about our school, compared to what I was physically witnessing and had witnessed in my career until that point, I was really starting to see a relationship play out between ABA and various other acts of oppression and violence. So combining that with what I was reading and learning about from self advocates, who were talking about their own experiences, and their own reflections on their treatment, I just really felt called to learn more, which is why I wrote this thesis.

Kristen Hovet  
Why do you think ABA caught on in North America, and became so appealing to so many?

Ciara Harte  
Before I get into why it became so appealing to so many people, I want to take us back a little bit, because in my thesis, I wrote about how in order to understand the complexities of the conversation around ABA, it's so important to know about its history and its origins. And I think that's true for any system or approach. It's s valuable to understand the roots and the values at the foundation of any of these things so we can know what the ground is that we're standing on. For me, understanding some of the history of ABA really helped me to understand the painful and ableist history of this approach, regardless of how it looks today. So to share a bit about that, ABA was considered an intervention for autism in the 1960s by a clinical psychologist named Ole Ivar Lovaas, who wrote extensively about his work with autistic kids. And his view was that autistic children were a blank slate, a quote from one of the readings that I include in my thesis is, quote, you start pretty much from scratch when you work with an autistic child. They're not people in the psychological sense, unquote. So Lovaas also spoke in his writings about the challenges that he was having in working with nonverbal kids and his belief that verbal consequences were not enough for this demographic, and that this is kind of what led him to using rewards as well as the physical aversives like beatings, shocks, and withholding food. 

Ciara Harte  
So to get back to your question of why it might have caught on in North America, in my thesis I wrote about how Autism Canada at that time, and keeping in mind, I wrote this in 2019 so now things might have changed. But at that time, Autism Canada expressed ABA is a popular intervention choice because of its use of tangible tools and simple instructional steps. And I also included some direct wording from Autism Canada at that time, which was that ABA could be viewed as a way to, quote, fill in the gaps for autistic children who may be, quote, less likely than other children to learn from the everyday environment. On a personal note, I think it caught on because of a couple of reasons. First, in our Western culture, we view so much through a medical model of disability, as opposed to the social model of disability. And I think I saw that you recently did an episode on that. But for the people listening who might not know, in a simplified way of explaining it, the medical model really is just that, it's the framing of our challenges and diagnoses as individual medical problems that happen within us, within our bodies. So therefore, the onus of the change or healing or improvement is back on the individual person. Whereas in the social model of disability, we shift that focus outside of us and back onto the social structures that exist around us. So then the intervention becomes, how do we adjust our social environments to fit the needs of the individual? 

Ciara Harte  
I think ABA leans into that medical model of disability in that it offers a way of putting the onus of change back onto the kid that's having a hard time. And a part of me can really understand that and how it comes to be appealing. When you think about how parents are seeing their kids suffer and have a hard time, they might be desperate to know how to help their kid. And this approach is being presented as the main option historically. Historically, also, other options just weren't necessarily as readily available, and the piece around how parents want to protect their kids from all the intersections of how we, in our Western culture, treat people that diverge in any way from what's considered normal. And I see this for so many struggles that people have, I come up against it all the time at work, and talk to clients about it a lot, how it's easier to ask an individual to change than to ask a system to change. And when you add in those various intersections of privilege as well, it can even be dangerous if that individual doesn't change or comply with what social expectations are because of the various levels of oppression or violence they might face if they don't.

Kristen Hovet  
I also remembered reading something about how, when ABA arose, it arose in a time when being normal was very, very important. And also during a time when parenting practices were very much about punishments and reward. So it sort of fit in nicely as sort of an extension of what was already going on in parenting at the time, or what was becoming all the rage at the time.

Ciara Harte  
Totally. That makes sense to me. Yeah.

Kristen Hovet  
For your thesis, you conducted a critical discourse analysis of six articles from the Journal of Applied Behavior Analysis. Can you explain what a critical discourse analysis is, and what it adds to the conversation or debate about ABA?

Ciara Harte  
A critical discourse analysis is a method of interpreting how we specifically use language. It looks at what the words are that are being used and how they're being used, as well as what is the information expressing through our choice of language. For my thesis, I chose to do a critical discourse analysis because I was really curious how ABA researchers use language in ways that might continue to oppress autistic children and present them in a particular type of way. I was inspired by an author named Donna Mertens, who wrote about transformative research. And she wrote about how a researcher's gaze should be turned to those privileged or in positions of power in order to confront social oppression, which is what I was trying to do through this thesis. And I made a deliberate decision to analyze ABA researchers' use of language because, in this situation, they're the ones that benefit from the status quo of ableism. 

Ciara Harte  
The journal I chose, the Journal of Applied Behavior Analysis, I chose it because it's a long standing academic journal. It's been in circulation since 1968. The edition I used was the summer 2018 edition, because that was most recently published at the time I was writing it, the articles are peer reviewed. But ultimately, I chose this journal because, even in the title of the journal, The Journal of Applied Behavior Analysis, it implies an air of being an authority on what's current and acceptable in areas of research and practice within the field of ABA. So then, to do the analysis, I chose a framework called the interactional and discursive view of violence and resistance by Linda Coates and Allan Wade. And this framework, like I was mentioning earlier, is based on concepts of response based practice. And what it does really is break down how do we use language in ways to conceal violence, obscure and mitigate the responsibility of that violence, conceal resistance against violence, and blame and pathologize victims of violence?

Kristen Hovet  
And what were your main findings from your analysis?

Ciara Harte  
I'll break it down as much as possible, but I go into lots more detail in my thesis for anyone that might be interested in that. The two main things that I believe came from my analysis were exposing violence within ABA, and highlighting the resistance of autistic children as they went through it. So I'll spend a bit of time breaking down those two things. For the first part, exposing violence, the first thing that I really noticed was how pervasive it was, in all of the six articles that I studied that the context around what was happening for these kids was almost completely removed. The ways that the researchers chose to write about these kids and introduce these kids made it so that they were solely definable and describable by their autism diagnosis, and by a set of so called problematic behavior. They removed all of the context to the point that, for me, it didn't even feel like I was reading about human children with complex, nuanced lives and feelings. And I feel like what that does is really lean into that medical model of disability. It intentionally places pathology within these kids, and removes any of the information that might explain what was going on for these kids in the moments before and leading up to the behavior. Another thing I noticed is that while the researchers were excluding most of the context of what was happening for the kids, and any conversation or information about consent was also excluded, what they did include and elaborate on were very detailed descriptions of how the youth behaved, particularly the things the youth were doing wrong. I think, you know, it's important to pay attention to what narratives are prioritized in these types of conversations because it works to almost excuse or add an air of credibility for anything that happens next. Some of the articles talked about how the researchers were looking to, quote, eliminate, or, quote, exert control over the behavior of these kids. And they would do so by deliberately setting up environments that they knew would trigger that behavior. For example, in one article, they gave an example of enclosing a child into a padded treatment room, and forcing her to listen to a stereo at a noise level they knew had previously evoked that behavior that they had deemed problematic. And there's different examples of other ways that happened in these articles, which are in my thesis. One of the things I highlighted in my thesis is that, in the six articles I analyzed, there were 28 children  participants, 50% of those children were between the ages of three to five years old, and none of the six articles spoke to the age or power dynamics that are so important to consider in any work that we're doing with kids. And that really comes into play when we start to look at what the language was that researchers used to describe these kids. What I noticed was that the language they used was so effective in reversing the positions of who is the victim and who is the offender in these types of situations. The language that they used positioned themselves, the ABA practitioners, as potential victims of, quote, aggression from these kids. And what's important about that, to me, is I'm always looking at what is the implicit messaging under the language we use. So the implicit messaging here is that these children, 50% of whom, keep in mind, we're between three to five years old, had the power and potential to significantly harm researchers or cause them to feel unsafe enough to merit wearing protective equipment. And one of the articles even talked about how practitioners were instructed that they were allowed to terminate the sessions if they felt unsafe. And that's so interesting to me because, again, keeping in mind here the age and power dynamics between adults and young children. And it makes me really curious about the safety needs of the kids. Like if they felt unsafe, were they rewarded the same opportunity to have protective equipment or to end the session? Did they know how to reach their parents if they needed to, for example. 

Ciara Harte  
Another piece that came up in my analysis is how researchers use language to misrepresent what their actions are. I noticed that the researchers in these studies use things like positive adverbs and adjectives to qualify what their actions were. In one example, an intervention was described as, quote, the instructor gently held the participants hands on the table, unquote, until the kid made eye contact. So the use of the word gently there. In another example, the researcher writes, quote, aggression resulted in a reprimand with a soft pat on the back or shoulder, unquote. And in this instance, it's the word soft that stands out. So at the same time that researchers were using really detailed language to describe what was problematic about the youth, they were also using vague and qualifying, positive language to describe their own actions. The consequences of doing that, of using these types of qualifying language like soft or gentle, is that it shifts readers' perceptions about the actions of the ABA researchers, right. Consequently, the readers of the article might not pick up on the realities of what does this actually look like? What's actually happening to these kids? So in my thesis, I offered a bit of a cheeky reframe. For that first example, where they use the word gently, I reframed it like, the instructor demanded their three year old participant to follow her eye gaze. When the three year old did not understand or respond as expected, the instructor pinned their hands to the table and refused to let go. Understanding the age and power dynamics influencing their options, the three year old met the researcher's gaze and followed her eye shift to the appropriate item. At that time, the instructor let go of their hands. So I think when we can reframe these actions and tell them from the perspective of the person with the least amount of power in the room, it highlights and honors a different type of story.

Ciara Harte  
So that was the first half, the exposing violence part. The next main finding from the thesis was highlighting the resistance of autistic children. I just want to come back to the fact that the power and age dynamics can't be overlooked here. But that discussion was completely absent from any of the six studies I analyzed. And so in those, ABA practitioners accounted in their studies for two different types of responses to their methods. And one was that kids would continue or heighten whatever behavior was happening. And the second one was that there would be an apparent compliance with their demands. Through my thesis, what I'm suggesting is that both of these types of responses could be considered a form of resistance against violence. When I'm talking to people about resistance, how that looks totally depends on the unique combination of things like the dangers and opportunities present in any given situation. When people are experiencing violence, what we know is that they can face retaliation for any act of perceived defiance or fighting back. And that retaliation on the act of the offender in this situation can become increasingly forceful, or scary, or confusing. And we see that with ABA. And it was evident in the way that these articles were written, that practitioners become intentionally more intrusive with any signs of defiance or so called problematic behavior. So if we start to link these things together, we can think about how we forced these young children into unknown, unfamiliar environments with adults that aren't their caregivers, and we're demanding these new behaviors from them, while ignoring the context for why they might be occurring, and the fact that these adults are becoming increasingly intrusive if they do continue to respond with behavior. In the articles, they wrote about how ABA practitioners moved from things like verbal demands, to more intrusive things like physical coercion, and that includes things like pinning hands to tables or swatting at children's shoulders, like in the examples from before. Through the articles, the children initially seem to respond with more of their so called problematic behavior. But then it seemed to me, as I was reading these articles, that on realizing that the ABA practitioners were becoming more and more intrusive with their demands, the kids switched their response to compliance. Once the children were seen as complying with their demands, ABA practitioners lessened the intrusiveness of their actions. Most of the kids in these articles seem to follow this trajectory where they switched to that compliance form of resistance at various points during their ABA experience. And what I think that speaks to is the children's knowledge and incredibly insightful awareness that continuing their behavior means that the adults in the room will escalate what they're doing and become more intrusive with them. So if you think about, again, the power and age dynamics that I've talked about, it becomes even clearer children know about power dynamics. They're so much smarter and so much more astute than we give them credit for. At the end of the day, that's why I called my thesis reframing compliance, because compliance is this word that gets thrown around as a word that signifies an intervention has been successful. But I really disagree with that. Because for me, what it tells me is that child or that person has so much inherent wisdom to know how to keep themselves safe from escalated harm, and to know how to respond in ways that uphold their sense of agency and dignity in the face of harm.

Kristen Hovet  
In terms of your findings, how did they change or inform your own opinions about ABA? Or did your findings confirm suspicions that you already had?

Ciara Harte  
I definitely think my findings confirmed my suspicions. And I do also recognize that my personal experiences in the field and the things that I've seen in the field definitely informed the lens I carried going into the thesis to begin with. But, really, it was reading the stories and quotes from self advocates that brought it all together for me.

Kristen Hovet  
You did mention that you had some experience. Did you go in to your practicum kind of being pro ABA, or when you first were introduced to ABA, were you more neutral or even pro and then kind of changed over time?

Ciara Harte  
Good question. I didn't know anything about ABA when I went into my practicum. I went in as a blank slate, as people might say. I had various different experiences and you know, some things felt, okay. And then other things, even in those moments were like, that doesn't feel very good. And then it was more, over time, as I was seeing different ways it was playing out, that I started to question things more.

Kristen Hovet  
I've read a lot and heard a lot about ABA myself, just since looking at this subject and since I was diagnosed, it was totally new to me. Many on the pro ABA side say that ABA practices have changed. In most cases, physical punishments or aversives, they say, are no longer used, and therefore it's not harmful to children, according to that argument. So what's your response when you hear something like that?

Ciara Harte  
My first thought is that I wouldn't necessarily say ABA has changed across the board. I know in my own personal experiences, and that was, you know, maybe five or six years ago from this particular thing I'm thinking about. But I witnessed, with my own eyes, kids being physically moved around, dragged even, by their interventionist or behavior consultant. And those are just the things I can speak to firsthand that I saw. But even without those practices, I think ABA can be harmful, even without the aversives. In my thesis, I referred back a lot to a report by someone named Ben Gardner. And it was written for the Autistic Self Advocacy Network in 2017. And that report included a lot of quotes and perspectives from self advocates. The self advocates in the report expressed that therapies like ABA that are designed, in part, to make them appear non-autistic, actually can do more harm than good. And one quote I want to share from a self advocate in this report is, quote, the therapeutic goal was presented as learning social behavior. In retrospect, this was learning to mimic neurotypical social behavior. It resulted in corrosive damage to self esteem and deep shame about who I really am. No effort was made to explain autism to me, or to explain the role of sensory overload in issues like meltdowns, shutdowns, etc. 

Ciara Harte  
Some of the other self advocates in the report talked about their own childhood experiences of being restrained during behavior intervention. And that, consequently, it became really hard for them to feel like they could trust people, to feel like they could feel safe saying no, as adults. There was one quote in there that felt really powerful to me, and it was a self advocate who said, coercive treatments, quote, teach you to anticipate that when you say no, they'll bulldoze through that because you don't own your own body. And, of course, I'm not saying this is generalizable to how it looks with every single practitioner or every single treatment because, of course, it doesn't. What I am saying is that I think it's critically important as service providers, as adults in positions of power over young children, to always be engaging in self reflection about the potential impacts of the work that we're doing with people. 

Kristen Hovet  
One common argument is that ABA is warranted because it's the best way to reverse or address self harming behaviors or behaviors that harm other people. So this seems to suggest that ABA is the only way to address these behaviors. Do you know of any supports or interventions that are successful in addressing these types of behaviors?

Ciara Harte  
Yes. There was one example about this topic that really felt very insidious to me in one of the studies I analyzed, for the thesis, where a 15 year old participant was receiving ABA because of his self harm behavior. And it was interesting to me because the self harm behavior was being framed as what the problematic thing was. Of course, we don't want our kids to be in positions where they feel like they have to hurt themselves, that is true. But when the study explained a little bit of the context of this particular self harm behavior, it was that the self harm was happening in response to his parents arguing loudly in front of him. And that's what I mean when I'm talking about the crucial element of understanding the context because the practitioner is replicating that environment and putting him through an extinction intervention to rid him of this behavior. But when you think about that context, first of all, that is so harmful that they did that. And second of all, there's so much else that could be going on. For example, how could we reframe his behavior as an act of resistance against seeing his parents in conflict? And I think about perhaps, on some level, this teen knew when he hurts himself, his parents stop arguing. And there are so many reasons kids do that and I see it at work, like protecting one parent's safety from another parent, protecting siblings or pets from the aftermath of a conflict, wanting to help parents calm down, or interrupt a pattern, or even just wanting to relieve his own distress by making the arguing stop. And, again, some of this context, hopefully, might have been addressed in the moment by the ABA practitioner, but it was totally excluded from the article. And, in excluding this, first of all, it gives this air of acceptability that their intervention choice was okay. And, second of all, it shifts the blame and pathology right back into the youth. 

Ciara Harte  
To get back to your question and answer it in my long winded way, is that it has to start with the context. Behaviors, as we know, they don't exist in a vacuum. They're a way of communicating that something is happening for that child or for that person. So how can we shift that energy outwards to help change whatever's happening in the environment that's leading up to that self harm or other related behavior? When we know what's leading up to that behavior, it gives us so many more options. And that might be things like, would family therapy be appropriate? Does the family need help? Do they need resources, if they're available? How could we involve services like occupational therapy, where we can help the child and child's family understand what their sensory system is and meet their sensory needs in a different way? In what way could we even introduce things like harm reduction? So, in my thesis, I write more about some of this stuff and some of the other alternatives to ABA that came out of that Gardner self advocate report. And that includes things like therapists might take on more of an advisory role, help kids understand their autism, help kids and families understand how to cope with things like burnout, sensory overload, and navigating these really crappy systems that are not set up for them. It also might include things like social groups and mentoring and mindfulness, teaching self advocacy skills, and other things focused more on increasing self care, rather than decreasing the amount they stand out from their neurotypical peers.

Kristen Hovet  
You mentioned in your thesis that target behaviors in ABA are those that are determined by the providers and or the child's parents. What the child wants seems like an afterthought, in many cases, or, sadly, is not even considered. What about client centered ABA? This is a term I've been hearing more recently, if that's such a thing, I don't know, where the child's asked what changes they'd like to work on. Do you think there's such a thing? Is that possible with ABA?

Ciara Harte  
I have lots of thoughts about it. And I would say, in order to be truly client centered, it has to start with informed consent. And that includes knowing what the benefits are to a certain approach, but also knowing what the risks are, and what the alternatives might be. It involves knowing that you are allowed to change your mind at any time, and you can take your consent back at any time. And it also involves knowing what a complaint process might be, or might look like if they have concerns about the care they're receiving. So I'd say it would really have to start there, and that's not just with the parents, but also with the kids. How do we take care in developmentally appropriate ways to address consent with all people involved in the process? But ultimately, I think it's up to each individual client to determine what is client centered and if they feel like they're a part of the process. The thing that comes up that's interesting to me, and I have a question that comes to mind and it's, but who initiated the treatment? And is that really coming from the kid and their hopes to work on or change something? Or is that actually being driven by an external source? A family member, a teacher, various other social pressures? In which case, who are we defining as the client that it's centering around? And how can we, if we're saying that the kid is our client, how can we sit with, listen, and honor what the kid really might want, even if that's different from what society wants for them? The last thing I'd say about this is that it comes back to language because it depends who is defining it as client centered. Is that being defined by the practitioner or the client? I don't think it's up to us as service providers, as people in positions of power, to determine what feels client centered. That has to be decided by the people receiving the service. And that's something that we collaborate on over time. It's not just a token gesture at the beginning of service.

Kristen Hovet  
Given your work and what you discovered by doing this analysis, do you think ABA can be changed enough to be non violent? Or, if it were to be changed that much, would it no longer be ABA at all? If that makes sense?

Ciara Harte  
It does make sense. And it's interesting because I was thinking about this as I was preparing for this interview. And I am partly of that mind of, if we're changing something to the point where it's not recognizable from its original form, or from its new iteration of the original form, why do we feel like we need to still call it that? And I wonder, too, in some ways, if we're still advertising ourselves as ABA practitioners, there is no way to separate ourselves from the history of what that means. And so for people that are seeking that out, specifically, they might have a very particular image of what that is, and whether or not we are following it to the letter or making our own version of that, it's just something that I feel curious about. I don't know if that answers your question?

Kristen Hovet  
Yeah, it's just something that I thought of while you were speaking. And it's like, yeah, I guess at a certain point because, I mean, at the root is behaviorism. It's really behaviorism that's the target in a lot of ways. I read about how, with behaviorism, they never really look at the internality or consider the internal landscape of the person. It's all about cause and effect. So if you get rid of that, I mean, that removes the whole basis for the quote unquote, treatment.

Ciara Harte  
Totally. Yeah, and then at what point do you maybe call yourself like a support worker or something? And could that maybe be okay?

Kristen Hovet  
Exactly. And I also read that, I don't know if this came up in your paper, actually, but the fact that the practitioners themselves don't need to actually know that much about autism. They're not trained in the latest and greatest research or anything like that. So it really is about behavior. And that's concerning to me, like having someone who's not grounded in that training and that knowledge.

Ciara Harte  
Yeah, totally.

Kristen Hovet  
Do you have thoughts on the debate? For me, I've only been in this space, the self advocacy space and even knowing that I'm autistic, for the last like four years. And I've really become aware of this strong debate and divide and controversy over like, either you're pro ABA, or you're anti and there's very little room in between, it seems. So to even have a neutral stance is very challenging. And I've heard bad stories of people calling names and just these divisions that happen online. I personally have felt forced to take a side. And also I've come to my own conclusion that I am on a side, like I would wish that ABA no longer existed or there were some other option. That's my position. But then being part of groups where there are very pro ABA people, it's almost like you have to pick a side. And it's either you're one camp or the other. It's really hard to be in the center. So do you have any thoughts on that debate and divide, or just how to approach it as an advocacy organization, or individual? Or maybe the way forward is to just continue that way, to continue having this butting heads constantly?

Ciara Harte  
The thing that comes to mind for me, I guess, is that really, I think it comes back, at the end of the day, to a holding space for witnessing humanity and listening to people's stories. And so I would hate for, you know, for example, for autistic folks who've been through ABA, I would hate for them to be put in this position where anyone could debate what their lived experience was. And I think that, as practitioners, or as people out doing this work, it's just so important to take a step back and listen to people's stories. It's not really worth engaging with people that aren't open to hearing about someone's humanity, which I wonder if sometimes that's kind of where that debate or divide comes from. And I'm open to be proven wrong about that. But is it really about trying to come together or find a new way, or is it about just not wanting to look in the mirror and reflect on things? And I can see what you mean about how it is so hard to try to find our own path and our own way, our own perspective on things, and not just be forced into accepting whatever narrative is being presented or being forcibly presented by one person or another. I really think that that just comes from, how do we sit back and listen to people's stories and then find our path from there.

Kristen Hovet  
I guess the other thing I've heard in the same space and organization is people who, they have children who are diagnosed with level two or level three autism with also intellectual disability, and they say nothing else has helped me, this is the only thing that's helped. They talk about experiences with going out in public and being shouted at and being called child abusers. So that's the other side of the story that I wish didn't happen, but it is happening. And so there's this like, I don't know, this triggering, this mutual triggering that goes on. So it's getting more and more heated, it seems.

Ciara Harte  
And, you know, what's interesting that just comes to mind, for me, is that I think, in that, it's almost like this systemic distraction from what the issue really is, which is ableism. And how ableism links into things like all the other systems, classism, racism, colonialism, and so to pit people against each other is like the oldest trick in the book. And then it becomes, you know, pro ABA or anti ABA instead of navigating parents trying to do their best against this system and a world that is so violently cruel to people that have various different support needs. And, as you were speaking earlier about autistic folks that had positive experiences, and for me, again, like those are a set of stories and a set of lived experiences that it's not up to me to try to fight that. That is real and that is true. And my hunch is that, and this is the same for any type of approach of working with people, you know, there's lots of therapy approaches, for example, that I don't do and I don't really agree with per se, but some people have great experiences with them. And what I think, in my mind, when I hear that, what it comes back to is a relationship between the person and the practitioner, and that, clearly, that was maybe really healing or really valuable to them in some way. You know, there's so much nuance and complexity to this conversation.

Kristen Hovet  
Definitely. Thank you so much. That was awesome.

Ciara Harte  
Thank you, Kristen.

Kristen Hovet  
That's all I have for you today. Thank you so much for being here

Kristen Hovet  
Until next time, bye.