Potential Side Effects & Concerns of Long-Term ABA Therapy

Psychological Harm & Trauma:

Linked to increased symptoms of post-traumatic stress (PTSS) and anxiety.
Can lead to depression, especially as a side effect of “extinction” procedures where reinforcement is withheld.

May cause psychological ill-being by suppressing intrinsic motivation and autonomy.

Increased Prompt Dependency:

Long-term therapy can create a reliance on prompts from therapists, suppressing autonomy and independence.

This dependency can persist into adulthood, affecting the ability to act independently.

Suppression of Self-Regulatory Behaviors:

ABA often targets “self-stimulatory” or “stereotypic” behaviors (stimming), which are crucial for many autistic individuals to self-soothe, regulate emotions, and reduce anxiety.

Forcing a child to stop these calming behaviors can be harmful and is often done to make neurotypical people more comfortable.

Erosion of Intrinsic Motivation:

The heavy reliance on external rewards can “crowd out” a person’s internal drive to learn and engage, particularly for tasks that require creativity and problem-solving.

Neglect of Internal States & Neurological Reality:

ABA focuses on modifying observable behavior while ignoring internal constructs like thoughts, emotions, and sensory pain.

Therapists are not required to have training in autism, brain function, or child development, leading to a fundamental misunderstanding of the autistic experience.

Issues with Compliance and Autonomy:

The primary goal of compliance can coercively close off paths of identity formation and align a child’s behavior with external demands rather than their own preferences and passions.

This has been compared to “conversion therapy” for gender identity, aiming to normalize behavior rather than support individuality.

Questionable Long-Term Efficacy for Nonverbal Individuals:

Despite decades of use, ABA has never been shown to be effective for the nonverbal autism population.

Large-scale studies have found that the vast majority of children show little to no change, and some may even experience a worsening of symptoms over time.

Ethical Concerns and Misrepresentation:

ABA therapists often present themselves as “autism experts” despite a lack of training in the neurobiology of autism, potentially constituting malpractice.

Providing a treatment that causes distress in exchange for no proven benefit has been described as tantamount to torture, violating the core medical principle to “do no harm.”

References:

• Eckes, T., Buhlmann, U., Holling, H., & Möllmann, A. (2023). Comprehensive ABA-based interventions in the treatment of children with autism spectrum disorder – a meta-analysis. BMC Psychiatry, 23(1), 133. https://doi.org/10.1186/s12888-022-04412-1
• Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., Unumb, L., Shapiro, S., & Khosrowshahi, D. (2022). Concerns About ABA-Based Intervention: An Evaluation and Recommendations. Journal of Autism and Developmental Disorders, 52, 2838–2853. https://doi.org/10.1007/s10803-021-05137-y
• Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5, 126–134. https://doi.org/10.1007/s41752-021-00201-1