CW: child abuse, ableism, torture
Ivar Lovaas: The father of ABA. Lovaas’ 1987 study is an ABA grad student’s second most important resource other than the White Book. It’s the source of the “40-hour rule,” which is usually in the context of early intensive behavioral intervention (IEBI) meaning it is aimed at children averaging in age 2-4. The earlier the better, of course!
Let’s take a closer look at the study that started it all.
The Rationale
Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children was published in the Journal of Consulting and Clinical Psychology by O. Ivar Lovaas in 1987. At that time, Autism was described as a “serious psychological disorder” that resulted in self-injury, “retarded IQ,” ritualistic behaviors, little to no expressive language, and an overall poor prognosis. The intervention was designed based on the hypothesis that neurotypical children learn naturally from their environment during all waking hours, while autistic children fail to do this. Thus, they would arrange the environment and the contingencies to make this learning happen for the autistic children, but at an accelerated rate, so as to “catch up” with their typically developing peers.
The Methods you need to know
Participants were chosen if they met the following criteria: A diagnosis of autism by a medical doctor or licensed psychologist, under 3 years of age if considered non-verbal or under 3.5 years of age if they displayed echolalia. These participants were then split into 2 groups: The intensive treatment group which would receive “more than 40 hours of one-to-one treatment per week,” and the control group which would receive “10 hours or less of one-to-one treatment per week.” The therapists were college students who worked with the children across multiple environments for “an average of 40 hours per week across 2 years.” Parents were also trained so that “treatment could take place for almost all of the subjects’ waking hours, 365 days a year.”
Aggression and stimming were targeted for reduction by ignoring, using time-out, reinforcing other behaviors to replace them, and shouting “no” or slapping their thigh (“as a last resort”). Only the intensive treatment group received physical punishment. The first year was dedicated to reducing these behaviors and teaching the kids to comply with verbal instructions. Other foundational skills such as imitation were also taught at this time. From the second year on, the focus was on expressive language and interactive peer play. When it was time to start preschool, general education teachers were trained to continue these programs and it was ensured that the kids were only placed in regular education classes rather than special education classes to avoid the “detrimental effects of exposure to other autistic children.” After preschool, the treatment hours were faded from 40 to 10.
The results and conclusions
47% of those in the intensive therapy group received normal IQ scores and passed 1st grade without supports as opposed to 2% in the control groups. However, the authors discuss that it’s difficult to determine whether the children were really “cured” of their autism or if “residual” effects were still present. They argue, however, that the outcomes were socially significant, in that the “successful” participants were indistinguishable from their typically developing peers. It was also noted that results likely would not have still occurred if they didn’t use aversives or if intervention began later than age 4.
Hence the idea that you have to start with 40 hours per week as soon as possible or it’s all hopeless for that child.
The study also concludes that the interventions made the families’ lives much easier, and that, without this intensive treatment, autistic children would continue to show “deficits” and “severe psychological handicaps” throughout life. That is, if treatment wasn’t started prior to age 4, consisted of an average of 40 hours per week, and included use of both reinforcement and punishment, autistic children would continue to be “burdens” on their families and would never become acceptable members of society. This intensive training also supposedly reduced the cost for caring for such individuals, down to an estimated $40,000 per year, as compared to the $2 million per year cost of institutionalizing them (the only other acceptable option at the time).
Re-examining the study
Generally, Lovaas is hailed as “the father of ABA,” and the Lovaas center is still providing services to this day. However, not everyone views him without criticism. In 2006, Ten Schoneberger published a meta-analysis of criticism for the study, including questions that were raised regarding the accuracy of the methods section in the original paper. A number of discrepancies are listed in the meta-analsysis:
1. Lovaas reports that groups were assigned completely arbitrarily, but actually groups were assigned based on staff availability.
2. Lovaas claims only children who had been diagnosed using specific assessments were accepted, but actually there was wider variety in the assessments used among participants.
3. In the intensive intervention group, participants who were under 3 years of age received 1:1 treatment for a range of 25-30 hours per week. Those over age 3 received 35-40 hours of 1:1 treatment.
Schoneberger also points out several confounding variables in the study, many a result of the fact that the two groups were not as randomized as Lovaas had initially reported. For example, the intensive behavioral group required extensive effort on the part of the participants’ families, including training, meetings, and data collection. The effort required could potentially exclude families who were lower SES or who lived far away from the study site. Families who simply weren’t willing to put forth the effort, for whatever reason, would also be excluded. There are a whole host of variables that come with those families’ exclusion that are too much to go into for this post. However, many of those issues remain issues in modern ABA practice today.
Lovaas himself could also only measure the data the participants’ families provided. There was no way to know what was actually going on when therapists weren’t present.
Extensive inter-observer agreement (IOA) data was also reported in the study, but there was no data on the number of errors committed during implementation. It was never defined what a “last resort” was and thus, no data reported on who was receiving how many reinforcers or punishers. Therefore, data is severely lacking on the type and quality of services received, including possible differences across specific learners and therapists. The lack of randomization between the participants in each group also presents issues for attributing success only to the intervention and not to other outside variables, such as school resources and environmental effects.
Lovaas’ Influence on ABA today
Interviews with Lovaas, such as this one from 1974 in Psychology Today, indicate that Lovaas had a much more flippant view of using punishment than was stated later in the 1987 paper. This interview includes his infamous quote: “You see, you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense– they have hair, a nose, and a mouth– but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but I/you have to build the person.” The interview reveals a lot about Ivar Lovaas’ thoughts on autistic children. He describes them as “disturbed” and “little monsters,” and continuously reinforces the conclusion drawn in the paper: That punishment is necessary for what he considered worthwhile outcomes.
Sure, his views could have easily changed in the more than a decade of time between this interview and the study’s publication, but there’s no evidence for such a change of heart in the paper itself. Considering that there was no specific criteria for using punishment, it doesn’t seem like much did change.
Though he expresses caring deeply about the children he works with, he constantly discusses them, as well as everyone receiving behavioral health services, as less than people. He says that in order to treat autistic children you need to see them as “human” rather than as “patients.” We have to wonder if considering them human took effort on his part. He explains further that some of the children referred to him had been previously strapped to a bed in a spread-eagle position to keep them from engaging in self-harm. This, as implied in the interview, is how patients are treated, as opposed to how humans are treated. He justifies his use of cattle prods and physical assault as freeing them from this fate.
It’s true many of these views make him a product of his time. Psychological “treatment” at this point was still dependent on things like straight jackets, lobotomies, and tranquilizers. No one who behaved “abnormally” was seen as anything other than something to be controlled– made less inconvenient or dangerous to those around them. These practices and views bled straight into ABA from its connection to psychology and ultimately lead to the creation of our code of ethics.
Functioning in a world that saw anyone who appeared or acted differently from the general population as sub-human, Lovaas saw himself as committing an act of love and compassion. This perception is a different kind of prejudice that’s unable to see itself for what it is. It’s “allowing” these sub-humans to exist and be present in our society, despite the “clear reasons” they shouldn’t be. It’s the people who say they can’t be racist because of how much they appreciate POC for their contributions to manual labor. It’s the assumption that these “lower” forms of work in society are the only thing suitable for POC because they are not quite as “good” or “smart” or “useful” as their white “superiors.” Again, supremacy tightly woven into a learning history breeding abuse.
Though a behaviorist, Lovaas also regularly makes wild assumptions about others’ private events, while records and draws conclusions only from his measurements of publicly observable behaviors. Thus, he manages to both ignore and not ignore private events at the same time. Sound familiar?
But let’s really consider how our society is different today. Do we still treat people who are different from us as sub-human?
I mean, yeah… generally.
Think of every mean tweet out there, every bully, everyone who gets pleasure at the expense of another person. Ultimately, the perception is that the person being laughed at is a little bit less than a person. Whether or not they have feelings is questionable at best, but those feelings definitely don’t matter. This attitude is present in all of the isms– ableism, racism, sexism, etc.– all of these require one group to be inherently “better” than the rest, usually by nature, otherwise the entire belief falls apart.
Regardless of the time he practiced in and our ability to criticize him for it, the goals, the intentions, all of it still resonates from then through to now. We literally base our practice on these methods, our basic “rules” stemming primarily from this one study that wasn’t even well controlled. The attitudes of the past come with everything else, and hide in even the most well-intentioned practitioners. Even when our ethics code was put into place, it was due to a rash of incidents even Lovaas himself would have probably found abhorrent.
And it’s still not quite sufficient.
Looking at the flaws in the study, we have to wonder: Why have we let the findings of this study become law? Sure, other studies have shown that 40 hours is effective, but what about side effects? Also, effective for what? The goal of making people who are different indistinguishable from their less different peers is not a commendable one.
So we then have to wonder: Even now, are we treating autistic people as humans, or as merely “not patients?”