07/11/2023
This practice has always been supportive of neuro-affirming practices like DIR Floortime and SCERTS. It is validating to see that the AMA now supports these services and is moving away from support for ABA.
"From the AMA House of Delegate Handbook:
Whereas, A 2018 study from the Centers for Disease Control and Prevention (CDC) estimated the prevalence of autism spectrum disorder (ASD) among adults aged 8 years to be 1 in 44; and
Whereas, Applied Behavioral Analysis (ABA) is currently the most widely available and commonly used state-funded form of autism therapy in Canada and the United States; and
Whereas, Autism treatment represents a fragmented industry that consists of a mixture of for profit and nonprofit organizations, with the top nine for-profit chains estimated to have a combined revenue of $547 million and a market value close to $2 billion with future growth expected; and
Whereas, An ABA software company reports over 3 billion in claims processed annually for about 1,300 practices highlighting the prevalence of ABA use as an intervention for individuals with autism; and
Whereas, Autism Speaks lists 3,194 centers across the United States who offer ABA therapy as of 2022; and
Whereas, ABA was conceived in 1961 by Dr. Ole Ivar Lovaas to condition neurotypical behaviors in children he viewed as “incomplete humans”; and
Whereas, Desired behavior is often defined by the adult or behaviorist without input or requirement of consent from the child and may include non-harmful stimming or coping behaviors; and
Whereas, ABA uses behavior modification techniques to eliminate behaviors deemed undesirable; and
Whereas, ABA practices are historically based in abuse such as holding autistic children's communication hostage through the use of their devices as leverage, and denying basic rights such as food and toileting privileges; and
Whereas, Modern ABA still abides by the founding principle of making a child appear “normal” or “indistinguishable from one’s peers”, which serves to separate the humanity of the individual with autism from desired behaviors; and
Whereas, A 2018 study found that Adults with autism who have received ABA are more prone to su***de; and
Whereas, ABA has been repeatedly linked to Post Traumatic Stress Disorder (PTSD), with 46% of 460 ABA participants meeting the diagnostic threshold for PTSD in an online survey; and
Whereas, Adults with autism have been continuously outspoken about the trauma incurred by ABA practices experienced in their childhood; and
Whereas, A 2012 literature review found the evidence base for services for adults with an ASD to be underdeveloped; and
Whereas, A 2018 Cochrane review recommend further research after reporting very weak evidence in support of ABA; and
Whereas, A 2022 informal online community survey found that 71% of adults with autism responded “disagree” or “strongly disagree” to the statement “Generally speaking, I support ABA therapy for autistic children”; and
Whereas, A 2020 Department of Defense report demonstrated a lack of correlation between improvement in symptoms and hours of direct ABA services, found that the improvements recorded were due to reasons other than ABA services, and ABA services did not meet the TRICARE hierarchy of evidence standard for medical and proven care; and
Whereas, A 2021 study on conflicts of interest (COIs) in autism early intervention research found COIs to be prevalent and under-reported, with 70% of studies containing a conflict of interest and less than 6% declaring them as such; and
Whereas, Current research supports alternatives to ABA such as the Developmental, Individual Differences, and Relationship-based (DIR®) program, the PLAY Project, individualized Early Social Interaction (ESI) and, Social Communication, Emotional Regulation, and Transactional Support (SCERTS®); and
Whereas, Current AMA policy supports the use of ABA through its advocation of coverage of ABA and the evidence-based treatment for autism and fails to recognize its harms or controversial nature within the community at large;
therefore be it RESOLVED… (American Medical Association [AMA], 2023, pp. 1179-1182)"
At the American Medical Association House of Delegates annual meeting last month, they adopted a resolution (Resolution 706) entitled, “Revi...
