Acorns to Oaks
Raising a child is never one-size-fits-all, and neither is therapy.
Acorns to Oaks is a podcast about helping children grow, families feel supported, and care feel more human.
Hosted by behavior analysts and healthcare professionals, each episode explores the real-world challenges families face, breaking down ABA, child development, feeding, behavior, and the systems that shape care today.
We believe in individualized treatment, compassionate care, and asking the most important question first: what matters most to your family?
Acorns to Oaks
5 Controversial Topics in ABA: Consent, Compliance, Neurodiversity, and Modern Care
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In this episode of Acorns to Oaks, Kristine and Sarah discuss five of the most common and important controversies surrounding ABA therapy.
They explore whether ABA helps children or teaches conformity, when intervention can become coercive, how consent and assent apply to young or nonverbal children, why total compliance should not be the goal, and whether modern ABA can support neurodiversity rather than suppress it.
This conversation focuses on ethical, individualized care built around safety, autonomy, communication, family values, and meaningful goals. It is especially helpful for parents who have heard mixed things about ABA and want to better understand what compassionate modern ABA should look like.
ABA has become a widely discussed and sometimes controversial topic, especially among parents, autistic adults, clinicians, and advocates. Some concerns come from outdated practices, some from poor implementation, and some from real experiences where therapy may have felt too focused on compliance, conformity, or suppressing differences.
In this episode, Kristine and Sarah do not dismiss those concerns. Instead, they talk through them directly.
They explain that modern ABA should not be about forcing a child to appear “normal” or teaching blind obedience. Ethical ABA should focus on meaningful goals, communication, safety, independence, family values, and the child’s autonomy. They also discuss why assent matters, why nonverbal communication should be respected, why total compliance can be unsafe, and why stimming is not automatically something to stop.
The larger point is that ABA is not one-size-fits-all. The quality, philosophy, training, and values of the provider matter.
Acorns to Oaks is presented by Nurture & Nature ABA, providing compassionate ABA therapy and parent support in Valley Village and the San Fernando Valley.
Learn more or schedule a consultation: nurtureandnatureaba.com
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This podcast is for educational purposes only and is not a substitute for individualized clinical care.
Greetings. You're watching Acorns to Ugs. I'm Christine Dixon, a board certified behavior analyst.
SPEAKER_01I'm Sarah Moreau, also a board certified behavior analyst and family nurse practitioner. And today we will be talking about five controversial topics in ABA.
SPEAKER_00ABA is applied behavior analysis. There is a lot of controversy happening right now regarding our science. Um, our science is dynamic, it's ever evolving. Uh, but yes, uh, I think it's important to have this conversation. Uh, I call ABA my my second marriage because when I learned about the science of behaviorism, I really truly fell in love. Oh, that's beautiful. Yes. But I do understand there's a lot of controversy regarding applied behavior analysis treatment. And I do think it's really important as someone that's been practicing now for 15 years to come forward and say the positives. But we can't say the positive with positives without addressing some of the controversies. So first question Is ABA therapy helping individuals or training them to conform to societal expectations?
SPEAKER_01I think that's a really interesting question. Um the reason I think it's interesting is because I think things have changed over time. And when we first started in this field, uh, I think that there was maybe a little more emphasis on conforming because at that time to conform meant more access to reinforcers, right? And more access to uh social interaction, more access to uh jobs or to education.
SPEAKER_00Um You're talking about the rule of automaticity, I think, which states that behavior analysts should create contingencies which allow the individuals in our care to gain and generalize these skills so that they can achieve natural reimbursers in their environment.
SPEAKER_01Absolutely. And I do think that that's important. It was important then. I think it's still important now, but I think that there has been um there has been some movement in terms of acceptance of differences, uh, which is a wonderful thing. Indeed. And I I just think that um one of the things we've discussed, I think in the past, is judging the past based on today. And and I don't think that that's necessarily fair.
SPEAKER_00You mean the revisionist history to look back spoke about the last time where it which is like, you know, during Henry VIII's time, what did medicine look like versus what it looks like now? I mean, it's kind of a laughable comparison. I mean, we have robots doing surgeries now, well, you know, we know so much more about the body. Yeah. Um, yeah, we have x-rays. You know, there's so many advances.
SPEAKER_01So many things change. And and that's a great thing. And I think, um, in terms of that question, can you read it one more time?
SPEAKER_00Yes, is ABA therapy helping individuals or training them to conform to societal norms?
SPEAKER_01And I would argue it can do both.
SPEAKER_00Yeah, I would say it is both because with cultural responsiveness, it's really about the individual family's values and norms. So, you know, if you know, are we gonna teach individuals to use a fork and spoon? Yes. Is that conforming to a societal norm? Yes. Will it benefit the individual? Yes. Will they use it in the natural environment? Yes. I mean, and don't get me wrong, I don't want to conform to societal values. I am a punk. I'm a punk rock girl from punk rat girl from the 90s, you know. I'm not about conforming to societal, but we all conform to societal values.
SPEAKER_01And it depends on the setting that we're in and what it is that we want for ourselves in that setting. So uh I love the fork and spoon uh analogy because there are some families that don't use forks and spoons that don't sit at a table for a meal, and that's okay. But to have that skill, to be able to go to school, where people are mostly like most likely sitting at a table eating with a fork or a spoon, it lets them be part of that environment if that's what they want. And I think um I think that's really where that question should live. Is that what they want for themselves? And if they if it is, then great. And if it's not, then maybe that's not an important goal.
SPEAKER_00Yeah, it's about individual, meaningful goals and outcomes and defining that for the for the family, for each family. Absolutely. Yeah. And what you want to teach your child and what you want for your child. That's where the goals and the treatment goals really come from.
SPEAKER_02Yeah.
SPEAKER_00Is those open-ended questions we first ask when we're getting to know our precious families. It's like, what's important to you? What are the biggest challenges for you? What are your values? What do you want to see? Um, because reading is conforming to societal values. It's a pretty important skill for independence. Yeah. Um, learning to count is a very important skill. Using a form conforms to societal values. So paying your taxes, I mean, I'm not teaching anyone to pay taxes. But but you know, how how much as a society do we have to conform to be successful? Like, if I'm a nudist, do I have to wear clothes to my job? Yes, because it's lawful. You have to wear clothes to your job, right? But does it go against my values? Maybe. I mean, I'm not a nudist, but um, you know, that's just one thing.
SPEAKER_01So no judgment to the nudists out there.
SPEAKER_00But that's extreme, that's an extreme example. Yes, you know, like I think when you look at successful people, they are adaptable. You know, they're very adaptable. And that adaptability is something that we do talk about in our science. We talk about generalization. Is it gonna adapt into the natural environment? Are they gonna get reinforced? Is it relevant in their day-to-day life?
SPEAKER_01Are they coming into contact with people where that skill would be really useful to have?
SPEAKER_00Yes. So I think we let the families or the individual define their own values and we work towards those values that are defined by the patient, the client, their families.
SPEAKER_01Um and at the end of the day, it's their decision whether or not they use the skill. We just want to make sure that they can if they want to.
SPEAKER_00I mean, another society conformity would be using money, right? It's like you don't go into the store and steal because there'd be real consequences, punitive and harsh consequences. So do we want to teach like the whole society system of money? Yes, we we probably do. Um, but always uh through the lens of the individual's family and values. And I think that's really where um some of the newer clinicians got lost.
SPEAKER_01Yeah.
SPEAKER_00Is, you know, we had this in ABA, we had, you know, this gold rush people call it, where these venture capitalists came in and they really did do a lot of harm. Yeah. I will say that because one of the uh talks that myself and Jose Rios did was we really looked at these assessments, and I think we we looked at over 50 of them to write about case formulation and how you gather and set the case and and does div design the treatment. And they were cookie cutter. Yeah. And I think when you are starting out and you're working for a big venture capitalist company, you don't have much support, you don't have much support, you can't phone a friend, you don't, you're not working with three B C BAs, like in our trainee program. Yeah, like the trainees get to work with so many BCBAs, they get so many opinions available to them. But I do think it really so it is a yes question, like we are, and it's a no question. It's a really it depends question, and it really is phenomenal behavior analysts get to know their clients, and there is absolute collaboration on the defining of treatment goals of what's meaningful. That's so true.
SPEAKER_01I think also uh not all providers and not all companies are created equal. So you need to make sure if you're getting these services that you're getting what you want out of them as a family and as an individual. Um because it's not one size fits all. It's so not.
SPEAKER_00Yes. Okay, controversial question number two. At what point does behavior intervention become coercion? Ooh. I think you know it should never have coercive uh contingencies in play. You should never be using an individual's personal items, objects. You know, you should be supplying the reinforcement.
SPEAKER_01Um be a fear or a you know, negative experience that's happening beyond replacing a behavior with something that's safe or something that's healthy for that person.
SPEAKER_00Um and I always say that safety trumps all treatment plans. Absolutely. You know, at the end of the day, you know, safety comes first. You know, don't follow the behavior plan if someone's safety is in jeopardy. And that's really what we train is that safety trumps any treatment plan. Um, so you know, there is a coercive cycle in ABA, Gerald Patterson. I think it's 1969, and uh this really describes a contingency between a parent and a child. And this is a really actually common contingency in which the parent gives a demand. The child puts up a protest, the parent then walks away and says, You're you better clean your room. If you don't clean your room this Saturday, there is gonna be no football on Sunday, right? And then uh the parent walks away and the child avoids the task. Um, and when I say the child, it could be a husband. I'm just saying it could be a husband as well. The the person that avoids the task. Then the parent comes back and uses more um uh threatening prompts. Uh clean your room, clean your room, then walks away, and then the child or husband doesn't do it. And and then it keeps just escalating up. And we do call that a coercive cycle. Um and you really change that and treat that with a high rate DRI, differentially reinforcing, which is crucial in our field. Absolutely. I mean, that's really at the simplicity level, we are differentially reinforcing behaviors. Well, what does that mean?
SPEAKER_01Well, so we are we are giving more emphasis, more reinforcement, um, more positive interaction for uh the behaviors that we're looking for. And we are not necessarily providing that stimulus if we are seeing another behavior. So, what we're trying to do is enrich that person's life uh as easily as possible to shape that behavior to something that's healthier or safer or better for them in the long term.
SPEAKER_00Yeah. So is ABA coercive? I would say no. I would say we're really looking to motivate and reward um behaviors that are good for the person, that are gonna produce more natural, like language, right? That's such an important pivotal behavior. So for me, it's a no.
SPEAKER_01Is for you a no? I I think it's a no. And I think it's something that we should keep in mind, though, because I think that um the way that we communicate what we're doing, the way that we implement what we're doing is really important. And and I think it's easy to have misunderstandings if we're not being really clear about what it is that we're trying to accomplish.
SPEAKER_00Yeah, and I really think that comes down to getting to know your clients and having open communication. Yes. Uh, and not taking on too many uh clients, you know, and really being able to understand um each individual. Um number three, can true consent exist in ABA, especially for young or nonverbal clients? Yes, I believe it can. Yeah, reaching, grabbing. I want to play, I want to engage, this is fun, I want to touch the bubbles, this is a scent that no one is going to make it more clear than a two-year-old if they consent or don't consent. So true.
SPEAKER_01Very, very clear.
SPEAKER_00Yeah, it is, it can be very clear. Um, you know, so much of our communication is nonverbal, anyways. So if you're really trained in in nonverbal communication, which we are, you can really pick up on those clues very quickly. And you should not move forward if you don't have uh assent or informed consent. Um, informed consent is really that legal term. It lies with the guardian. Yeah, right. Um, but assent is in treatment if a child is showing distress or does not want to engage, we back off. Yeah. And you should. You should.
SPEAKER_01Yeah, you should. Because really, you're going to be most successful uh if you have buy-in from the child.
SPEAKER_00Yes.
SPEAKER_01You they should want to be learning. Yeah.
SPEAKER_00You have to pair yourself with so much reinforcement that you are the reinforcer. Yes. That's what brilliant behavior analysts do. They're like, we're gonna have so much fun. And I think, you know, that is really I don't know, I don't want to get emotional here, but that's really one of the most phenomenal things we've done is like at our Saturday Social Club, it's so fun for the children. First, you know, there's nothing they can't go on or climb, you know, very little, you know, maybe something in the back room. But other than that, the whole space, they can go, they can run around, they can climb, they can ride the unicorn, they can body slam the inflatable dinosaur, like they can, you know, and um they're interacting with each other and uh it allows for a lot of autonomy. And I think this is what the question is really asking. Does can ABA provide autonomy to um clients and patients?
SPEAKER_01Absolutely, it can and it should. And if it's not, then something's wrong.
SPEAKER_00Yeah, then switch. Yeah.
SPEAKER_01Yes.
SPEAKER_00Okay, question number four Is compliance still an unspoken goal in modern ABA? Is compliance an unspoken goal? I I don't think it's unspoken. I think it's pretty much, you know, following directions is important.
SPEAKER_01It is important, and sometimes, you know, uh disengaging from an unsafe behavior is a really good thing. Yeah, super important. Um, I also think um, and I I know you and I have talked about this a lot in the past, but uh I'm non-compliant. I've done several non-compliant things today, and I dig that about you, Sarah. And I think having those expectations that we're never going to get to zero noncompliance, and that's a good thing because it is a good thing. We want to have um bodily autonomy. We want to be able to say, no, I'm not going to do that. And we teach those skills.
SPEAKER_00We do teach those skills. We teach no, I don't want to. I don't like that. I don't like that. I don't want to. I need personal space. I'm not ready to do that. Yeah. More time, please. We teach these self-bad because these skills. Yeah. And sometimes parents are like, he's saying no a lot. It's like that's a good thing. Yeah. We like clinically, actually, you don't want total hundred percent compliance because that would be extraordinarily unsafe for every individual.
SPEAKER_01Yes. Yeah. And I think that that is a big concern that people have about ABA because of things that have happened in the past, um, where maybe there has been an emphasis on total compliance with certain approaches. Uh, we don't do that. And again, I think if if you're seeing total compliance, yeah, that's scary. Something is wrong.
SPEAKER_00Yeah. Yeah. That's big brother.
SPEAKER_01Yeah.
SPEAKER_00That's that's it. That's that's you know, diving into sci-fi a little bit. No one should be doing um uh total compliance. Yeah. I mean, I do think following one-step, two-step, three-step directives is important because it teaches skills like important skills, like look both ways before you cross the street. Yeah, and how to make a pizza. Yeah. You can't make a pizza without learning directions. That's you know, um, but uh and safety, of course, like look both ways and um and don't touch the stove when it's hot and things like that. Yeah. Yeah.
SPEAKER_01Yeah.
SPEAKER_00But you know, don't mouth things that are on the ground. Right. You know, um, things that can have serious consequences. And I think when we look at compliance and talk about it, we have to look at uh what the natural consequences would be if they didn't get a skill. Absolutely. Yeah. I mean, I think it would kind of be very interesting to have a child develop with a parent never telling them no. I I wonder what that child would be like. Um, you know, it's like I that's compliance, right? Is like I say no, you know. Yeah. And you have to respect that, right? Yeah.
SPEAKER_01There's a lot of movies actually where I think that was displayed. Are we talking Varuca Salt? Yeah, Verucca Salt, uh Fing at the Sundance uh film festival, uh, had uh um a little girl and and also a grown man in that in that show that had never heard no um super fun, super fun characters, but yes, important skill to learn.
SPEAKER_00Yeah, especially if you're an exp uh your child or you are an experiential learner. Um, these are learners that want to do things and want to test boundaries. And that was the kind of kid I was. And uh so compliance of don't do that was really important because I could have gotten really hurt. Yeah. And so there is a lot of safety things, you know, like car safety, stay close to me when we're in the mall. Like these type of safety skills that are important, that compliance has to, yeah. And there's lawful compliance. You have to wear your seatbelt, you have to go to school.
SPEAKER_01Like you have to keep your hands to yourself. Yeah, you know, you can't just take things from other people, right? So, so there's important safety and social implications for learning. Certain things are a must. Yeah, and I think that's true in all parenting.
SPEAKER_00Like, you know, you can't eat your poop. Like these are universal laws because you'll get really sick. So, does this fall within ABA or does this just fall within parenting? I think it's kind of equal. I think, yeah, I think it's both. I don't think ABA teaches more no skills or compliance skills. I think, you know, children need boundaries and and safety skills and and also they need to be able to say, I don't want to. Yeah, and that self-advocacy and that autonomy is crucial. Yeah. And I think that's really where the complaints come in. I think so too. Yeah. Yeah. You know, we don't teach even in language, and we never did. I think the DTT model, which is discrete trial training, really teaches rote responses. Yeah. And very early on, our practice was like, oh no, you can say instead of saying like, hi, how are you? And I get that. And there is a roteness there to the DTT in in language sometimes as a side effect. Um, I think uh when you teach multiple exemplars, it allows that autonomy for the individual. I can say, hey, how's it going? Hi, how you doing today? What's up? You know, I can say all these different greeting variations, but I get to choose. So I think the way you look at compliance and treatment is through choice making. Yeah. I agree. Yeah. So, okay, question number five. Does ABA support neurodiversity or is it just suppressing it?
SPEAKER_01I think this is another one where we have seen change, which is great. In the past, did it suppress neurodiversity? I think you could argue that it had in the past. I think you can.
SPEAKER_00Yeah. I think I can see that in the 70s and the DTT trials. There's a lot of, you know. Yeah. But is it revisionist? Are we looking back, you know, exactly 50 years to say that was wrong, you know?
SPEAKER_01Yeah. Yeah. And and then a time when things, expectations were different for people to interact in the world. Now I think there is more understanding, there's more acceptance. And ideally it should be neurodiversity affirming because what we're doing is looking at that individual and what their goals are for themselves. Not our goals for them, but what do they want? And we're just helping to facilitate that.
SPEAKER_00Yeah. And, you know, I'm about independence and functionality. You know, I want skills that matter. Yeah. You know, I don't want to work on skills that aren't gonna promote um independence and and fostering independence. Um, you know, language is such an important skill, like I keep saying. So uh, you know, is it important to teach? I think so. I think language is a pivotal behavior. It gets you so many different very varieties of reinforcement. And I also think going back to, you know, when it started, uh, and Temple Grandin's video does a movie does a great job of showing this, is like it was kind of rare. It was much rarer than it is now. There is much more acceptance, and that's a great thing. It is a great thing. Yeah. Because even with ABA, you know, it it's not gonna change your personality and it's not gonna change your diagnosis.
SPEAKER_01And I think what this question often gets to uh is a topic of stimming, right? So self-stimulatory behavior that can look like hand flapping, making sounds, um uh holding certain objects, things that maybe bring comfort to some people.
SPEAKER_00Um and it it, you know, one of the things I think is that it's not just for the autism community, everyone stems. And if you were to put an individual in a room with very limited stimuli, like a white room, everyone would start doing these stims.
SPEAKER_01Yeah, we would all crack, we play with our hands. Absolutely, we do. We do. Um, so stimming is for everybody. Stimming is for everybody, and I think that uh even when those stims maybe look different than they do for you, maybe you and me, um, it's really about that person's choice. Yeah. You know, if they want to engage in that and that gives some comfort, that gives them some sort of uh uh input that feels good, as long as we're not hurting ourselves or other people. I think that that's probably uh a fine thing to do. In the past, though, I think there has been a push to not do any stimming at all, right?
SPEAKER_00Well, I think that comes back to the variable of acceptance and neurodiverse affirming uh care and and more, you know, autism speaks has done a good job of really getting um just more information out there on Autism Awareness Day. And, you know, I think as society accepts more, um, you know, I think it's it's a good thing. I think when you look back 50 years and you saw someone stimming, uh, there was an air of confusion around what is going on with this individual in the grocery store who is flapping and jumping. Now there is awareness, and people are like, he's just grooving and stimming and it's great, you know. And he's fine as long as it's safe. Yeah, as long as he's safe, and yeah. And I think we all do have stems, and I think it's absolutely we do. Yeah, it's fascinating to kind of study your own stems, yeah, uh, for sure. Um, and that's why sometimes things like toys and desk toys and things really work to help with focus, is because you know you have extra energy and it and it's uh it's a good thing. It is a good thing, yeah.