（一个美国家长的）一封公开信

——给准备让自闭症儿童参与高度行为训练的家庭

http://www.astraeasweb.net/politics/aba.html

发表于这个网站的连续三篇文章，我们将陆续刊出，感谢我的学生帮忙翻译

（如果你们怀疑这些美国人叙述的真实性，请给下面的英文里的联系地址写信）

欢迎转载，是那个网站说欢迎转载的哦

 

尊敬的家长们：

如果你们正在考虑让深爱的患有自闭症的孩子在家里（或在其他地方）参加应用行为分析治疗（Applied Behavioral Analysis, ABA）方案的话，那么请慎重考虑以下内容。

我们有一个非常有爱心并且信任他人的儿子。他活泼开朗，仅仅在摔得很疼时才会哭。

    我们感到很幸运，我们的儿子仅仅有一点轻微的自闭倾向，他的话比较少，但他并没有暴力倾向、攻击性或是焦虑。他喜欢与他人打交道，我们认为他是个性格外向的孩子。

但是现在，我们成为了举国闻名并高度引人注目的ABA训练方案的受害者。ABA的训练人员来到我们家，他们看上去很有能力，他们具有管理者的责任，并有条理地训练着其他孩子。但是经过一年的训练治疗，他们剥夺了儿子成长所必需的经历。在一项25分钟的干预治疗（其中包括当儿子哭喊并试图摆脱训练时所遭受到的强迫限制和大喊大叫）之后，这项治疗最终摧毁了儿子的情绪和心理健康。我们亲爱的儿子曾经多才多艺，最终被有意推入了难以忍受并无法控制的焦虑的深渊中去。

如今，我们的儿子被诊断出同时患有：自闭症和创伤后应激障碍（PTSD）。

这不是折磨他的疾病的一种轻微变化，相反，正如我们曾经在那些经历过数次战争或是强奸的受害者身上看到的一样，这是一种最严重类型的心理障碍。通常情况下，这是有心理疾病的人所受的创伤。创伤后应激障碍对于患者相对更为严重、更具有创伤性并且更持久。在 “治疗”的最后24小时中，我们儿子变得不可预测的暴力。现在，他整天处于焦虑状态中并且频繁的哭泣。他有病理性重现、侵入性记忆，晚上还会做噩梦。这个曾经随和的四岁男孩如今变得持续恐惧，很容易受到惊吓，并且会有不自主的抽动和防御性动作。他最基本的信任已经被摧毁，他开始避开人群。此外，他甚至不能靠近任何教学材料或者教学工具（积木等），因为这些教学材料曾被用于他的行为训练方案中，所以每次接近这些东西，他都会产生严重的恐慌。尽管我们努力去克服，但这些症状已被证实是难以消除的。在那可怕的一天中，我们感觉仿佛失去了儿子，而夺走儿子的正是声称使用“积极训练”并且“没有厌恶”的治疗方案。

家长们，请考虑并了解一下非行为治疗方法例如游戏疗法！“恢复”这一饱含了我们对儿子满怀希望的词语，结果却变成了在行为语言中一项实验性的操作定义的术语。这与那些ABA倡导者最初告诉我们的相距甚远，而这些人目前仍然在用孩子们做实验。

 

家长有权知晓对伦理道德的违反

    如果你正在或即将参与一项行为治疗方案，那么请仔细阅读这些关于违反伦理道德的条款。该编码取自美国心理学会心理学家的伦理道德原则和行为准则。

一、治疗师仅仅声明或暗示你的孩子在使用他们的方法后将有可能“恢复”，但对 “恢复”这个术语的狭义定义却不加以解释，这个狭义定义曾用于1987年Lovaas的研究，至今，他们也许仍然基于Lovaas的研究从而提出他们的陈述和声明。

3.03避免虚假或欺诈性陈述

   心理学家不能做出虚假、欺诈性的、误导性的、欺骗性的公开陈述，无论是他们所暗示的内容，还是他们所承诺的内容，都不允许是虚假的。

二、治疗师不会给你知情同意的机会。

    4.02对治疗的知情同意

   心理学家拥有专属的知情同意…必须告知人们关于治疗流程的重要信息…轻松地传达信息，不要对表达认可产生过分影响…同意或认可要通过合适的文件证明。焦虑障碍仅仅是自闭症的症状之一，比较常见，却并不显著，目前还没有研究探讨这种治疗如何有可能在之前并未患有类似障碍的孩子身上引发焦虑障碍。

我们的解释：知情同意自然应该包括风险-效益分析。我们并没有被告知关于这项治疗的任何风险，也没有被告知关于这些特定行为干预的名称、描述和解释。相反，他们试图避免给予我们那些重要的信息。治疗师们避开直接的问题，声称他们没有时间来解释，间接地回答问题，迅速转换话题或仅仅耸耸肩。我们得知的都是些对于那些干预方法及其结果的不科学的模糊委婉的说法，例如“让他坐在他的位子上”（身体限制），“发脾气”（当他试图表达他的郁闷时），以及“他会挺过去的”（当他开始表现出创伤后应激障碍的症状时）。即使我们夫妇二人都具有学士学位，但对于治疗过程的知晓仅仅处于六级水平。

此外，他们极力将陪同的家长赶出治疗室，这样使得家长更难做到知情同意。陪同的家长遭到口头上的攻击，被指控为利己主义、没有能力的，并且“妨碍了孩子的‘恢复’。”当母亲反对治疗者弄哭她的孩子并使孩子满脑子都处于焦虑状态时，她遭到的是治疗师粗鲁并且激进的大喊“不要妨碍治疗！”这种高压力下的说服正是毁了我们儿子的这种治疗方案的特征。作为父母，我们受到轻视，与我们商谈但却不听取意见，被大声的呵斥，不被理会，被蛮横地纠正，并被直接侮辱。一旦我们试图对这种明显有害的行为进行阻止，我们所受到的强制就尤其厉害。角色倒置也很明显，比如从他们与我们说话的方式来看，似乎我们是他们机构内部的雇员，而不是雇他们来为我们服务的雇主。

治疗者们并未对限制（例如：无论孩子发多大脾气，要求孩子一直待在自己的座位上）及其与痛苦的紧密联系向我们进行描述。限制很可能是在整个治疗过程中对你的孩子造成伤害的最危险的事物，也正是它对我们的儿子产生了严重的伤害。后来我们发现，风险和“副作用”是行为主义者最基本的知识，但家长却对其一无所知。我们从未听他们提过“退化”这个术语，但是之后，一位著名的行为学教授却告诉我们，自闭症儿童在ABA训练中产生退化是正常现象。

我们没有得到警告（知情同意中很重要的一步）说这类治疗有可能使孩子变得暴力或焦虑，相反，我们被告知：

＋如果你的孩子现在没有暴力倾向，那么由于他的自闭症，他将来有可能会产生暴力倾向。

＋如果他“毫无理由地”退出，那么你应该给他进行一项神经学的测试。（这个表面听起来是合理的，但是它的上下文及其防御性口吻掩饰了我们目前认为的归因回避——即，他们企图掩盖孩子行为的明显原因）

＋“焦虑障碍”仅仅是自闭症常见并不显著的一部分。（目前还没有研究探讨这种治疗如何有可能在之前并未患有类似障碍的孩子身上引发焦虑障碍）

三、治疗者故意并毫不犹豫地违反了普遍接受地孩子健康成长的基本条件和常识。

1.04 能力的界限

   心理学家必须先从某个新兴领域或新型技术的专家那里进行适当的学习、训练、督导以及咨询，然后才可以向公众提供服务、教学和新兴领域的研究指导或如何运用新型技术。

   我们的解释：父母作为儿童发展和儿童心理领域里经过训练的专职人员，假定由于许多行为学机构知识匮乏、缺少人类定向原则的训练，因此他们没有资格将研究自闭症儿童作为基本的反射或动物行为那样去对待。行为主义的危险的哲学基础仍然不能与对个体的尊重相一致，也不能认识到残疾人群的敏感性，更不用说每个儿童尝试去对他或她的世界做出自己解释的价值了。行为主义不尊重儿童对他自己的世界表达创造性的权利，尽管这是未来他面对各种陌生情境时应该具备的基本能力，这种能力使他拥有自我满足所必需的基本安全感和自信感。

 

对儿童情感发育的侵犯

    我们发现行为主义的哲学基础中最有危害的后果是对个体保护自身神圣权利的侵犯。也正是这种侵犯伤害了我们的孩子：孩子有保护自己免受焦虑困扰的权利，但这一最基本的权利却被剥夺了。当他需要逃离这种他既不能理解也不能忍受的情境时，他却受到强迫性的限制，而治疗者却说：“我们让他做的仅仅是坐在椅子上。”他的世界彻底被否认了，就象他的世界并未存在一样。他们甚至忽略他寻求帮助的哭声。这个术语叫做“消退”。但真正被消除的并不是单单“发脾气”的这个行为，而事实上是儿子最基本的安全感、调节情绪的能力，和对道德行为的理解（即“当我受到伤害时，爸爸妈妈会帮助我的”）。

行为主义者否认孩子情绪情感的重要性，而他们也是以此为依据来对待孩子的。例如，当母亲认为儿童无法理解自己所受到的指令，因而反对她在工作室得知的那种行为干预时，得到的答复是“他最终会理解的。”从心理动力学及主流发展心理学的观点出发，这明显是不合时宜的答案。由于孩子所做的一切都会被移除并重新来过，因此设定这样一个孤立的尝试训练情境的实质使得孩子情绪沮丧并且哭泣。积木曾经是儿子最喜欢的玩具，他过去总是用积木搭建自己喜欢的东西并从这种对积木的统治和成功中体会到巨大的愉悦感，但是现在，他们经常打断并拆除他的作品，这对儿子来说是严重的惩罚。当其他人控制着整个情境时，又如何能让孩子展示他的控制感并享受其成功呢？我想我的儿子正经历着这种称为“神秘化”的过程。R.D.Laing提出“神秘化”这个术语用来解释内心世界与外在现实间的困惑，解决这种困惑需要排除自己的情绪。孩子所有的情绪反应将被缩减成一个参数：顺从或非顺从，完全愿意或发脾气。这样简化一个人控制感的结果将会是负面的。我们的儿子就是在这种方式的作用下，由他自信心和积极性的轻微损伤，导致目前严重的伤害。

处理家庭中儿童虐待的专业人士都知道，儿童虐待的首要原因之一是不恰当的发展期望。然而，为我们儿子提供行为治疗的机构不止一次的告诉我们，这种治疗的目标是让我们儿子达到同龄人的标准。因此这其中隐含着对孩子做他自己的消极后果（惩罚），也就是说，孩子们的行为要与其发展年龄一致，正如一个生理必然性一样。孩子的行为必须与其发展年龄一致以与他自己情绪及理解保持同步。因此，强迫孩子做到一些事，比如“礼貌的请求”（这对于一个18个月大的婴儿来说要理解是不可能的，2岁的儿童也难以理解）便成为一种不恰当的发展期望。

我们认为，将拥抱和亲吻这种我们通常用于表达情感和爱的动作，作为工具用于许多行为治疗方案中，对孩子的情绪发展会造成很大伤害。他们要求孩子给予或接受这些动作，这作为训练的一部分，却不顾孩子的真实感受。这些“行为”因而对于孩子来说产生了不同的意义。由于某种行为的意义脱离了通常产生此种行为的背景，因此，如果你的孩子处于ABA训练方案中（我们儿子正是参加过类似的训练），那么他（她）很可能会在这个方面产生强迫性的行为。在训练中，拥抱和亲吻意味着“我放弃（控制自己的计划，理解自己的痛苦，反抗你的意愿，尝试获取自由，追求自己对玩具操作原有的兴趣）。”他们的意思是通过完成所要求的拥抱和亲吻动作来“从中寻求安全感”，因为“我已经学会了这个动作从而不再痛苦了（我选择谁来获得我的感情的权利也随之不存在了）。”因此，孩子们不再指望“这些行为”可以自由真实地表达爱和情感了。

 

行为学技术的其他负面影响

在儿子参与训练治疗的过程中，我们注意到ABA治疗方案的许多其他的负面影响：

1．初级强化物的不恰当应用

    ABA方案将日常生活的基本和必要组成部分作为“初级强化物”用于治疗，因此混淆了这些强化物原本的含义。例如，我们儿子并不能将治疗过程和与家人围在桌边一起吃饭做出区分。虽然他可以熟练地自己吃饭，但是，当他习惯了在每次割裂的实验之后由于其“正确的”行为而得到强化然后得到他人喂食之后，他在桌边时也不再具有主动性。（我们反而停止最初强化物的使用。）这种治疗不仅坚持使用食物来作为奖励，甚至还会从儿童嘴中移走食物。我们假定将食物作为条件性奖励的方式进一步妥协了儿童的基本信任并且为进食障碍的发生创造了条件。

2．强调部分还是整体（例如图片还是书籍）

参与ABA训练之前，我们的儿子一直对整本书籍有浓厚的兴趣，我也会读大量书籍给他听。在参与短暂训练之后，他对整本书籍不再感兴趣，反而似乎开始关注作为任务的某一页内容。他似乎失去了之前对整本书动态的理解能力，这并不意外，因为他不断训练关注那些与故事主线相隔离的毫无意义的部分或图片。

3．缺乏对自发性言语的关注

    我们观察到这种ABA治疗方案严重阻碍了儿童自发性言语的发展。由于大多时候都有时间限制，孩子们没有时间去发挥其创造性的想象，也无法追求他们自己的兴趣。在做分离训练的这一年中，他没有自发的使用过任何训练过的语言。事实上，他的所有的自发性言语和创新性语言都仅仅来自与我们——他父母的互动。创新性语言特别容易产生于游戏情境中，那时他很开心、有探索精神、具有创新性。游戏疗法和言语疗法因而比ABA疗法有效得多，并且也不危险。ABA仅仅展现出一项技能：机械记忆单词的能力。我们的孩子在参与ABA训练之前就能做到。

4．使用限制；激发焦虑

    我们观察到训练者将椅子作为一种惩罚的方式。如果我们的儿子生气了或者做了训练者们不喜欢的事情，他们就会说：“好，坐回椅子上！让他干活！”这种受到限制或“被束缚”在椅子上的情况，意味着孩子没有任何行动的自由也许甚至处于痛苦中，这引起了极度的焦虑。由于控制者对于孩子来讲是个完全陌生的人，因而这使得焦虑水平更加恶化。即使存在假定的安全措施（诸如在进行ABA训练的第一个月，要求儿童在椅子上一次最多只能坐3分钟），当这种情况严重或使儿童难以理解时，焦虑也会加以累积。而身体无法感受到诸如“现在我离开椅子并且可以完全放松，感到安全了”之类差别，即便儿童离开了当前情境，也会存在因被迫重复、限制、被操纵而产生的残余痛苦、焦虑、和惊恐。

5．“消退”导致的退化

    我们逐渐相信通过以消极方式回应（或根本不做出回应）对消除某种目标“行为”来说是很危险的。要知道我们消除的不仅仅是“某种行为”：与最初在动物研究中提出的相反，在消除人的某种行为时情况要复杂得多。被压抑的是“选择”，其中包括儿童内心理解的深层次重构。如果被消除的行为是他表达郁闷的方式，他也许会觉得当他受到伤害时不应该寻求舒适。他也许觉得应该掩藏痛苦并使其躯体化（例如产生诸如胃痛之类的其他症状）。他也许得出结论：没有人爱他。他也许会变得惊恐并像我们儿子一样产生创伤后应激障碍的症状。

6. 退化的重要性

    在儿子受到伤害后，一位著名的行为主义学家告诉我们这样总体的退化在自闭症儿童中很普遍。但是从心理学著作中我们发现，这种突然大幅度退化仅仅会发生于患有广泛性发展障碍的一种罕见类型——雷氏综合征的患儿身上。有没有可能这种突然的大幅度退化普遍发生于ABA训练中而不是自闭症儿童呢？我们发现这个前提与我们接受的深层次心理学训练相一致。根据西格蒙德*弗洛伊德的理论，当个体受到严重创伤或巨大焦虑时会产生退化现象。我们假定行为改变可以引发许多严重的病痛和失调。

7. 侵犯家庭的神圣

    我们认为儿子的创伤后应激障碍如此严重并持久的首要原因之一就是对他身体的侵犯，即以痛苦和可怕的限制的形式对他自己的家庭形式造成了侵犯。家庭应该是绝对安全的地方，应该是我们可以放下防备休息的地方，应该是我们感到被保护的地方。事实上，一些最严重的PTSD案例的伤害就发生在受害者自己的家中，因为我们往往期望家庭是最安全的，于是当家的安全突然遭到侵犯时，儿童最容易受到最严重的伤害。

8. 情绪反应缺失

    将所有消极反应称为“脾气”是一种危险的简化方式，这种方式将所有有效的情绪反应综合成一个词语来描述消除某种行为的过程。我们假定有可能我们的孩子正由于他内在的情绪系统而发脾气，但自主神经系统却被撕裂了。

 

家长们，我们写这封公开信的目的是让你们能比我们当初多了解一些关于ABA训练治疗方案的副作用。当初却没有人告诉我们这个。我们希望你们在听过“另一方”的声音后能做出明智的决定。

 

愿上帝保佑你

 

AN OPEN LETTER TO FAMILIES
CONSIDERING INTENSIVE BEHAVIORAL THERAPY
FOR THEIR CHILD WITH AUTISM

Courtesy of Virgynia King and Graphic Truth.
You may write to Virgynia at virgynia at wampi dot org.

This letter first appeared on the Children Injured By Restraint and Aversives support website.

 

Dear Parents:

If you are considering an in-home (or out of home) Applied Behavioral Analysis (ABA) program for your very much loved autistic son or daughter, please consider the following.

Our son was a very loving and trusting little boy. He was joyful, easy going, and only cried if he got a significant bump from falling. We felt very fortunate since our son was mildly autistic, has a little language, and especially because he was never violent or aggressive or anxiety-ridden. He loved meeting people and we referred to him as an "extrovert."

We are now victims of a nationally-known and high visibility ABA program provider. The ABA trainers sent to our home appeared very competent. They had supervisory responsibilities. They trained others within their organization. But over the course of a year's treatment they deprived our son of needed developmental experiences. This treatment culminated when they destroyed his emotional and psychological health in a 25 minute intervention involving forced restraint and yelling while he cried and attempted to free himself. Our gentle son was very skillfully and purposefully pushed into unbearable and unmanageable anxiety.

Our son now carries a dual diagnosis: autism and POST-TRAUMATIC STRESS DISORDER (PTSD).

It is not a mild variation of the disorder he is plagued with. It is of the severe type that most of us have seen displayed by war veterans or rape victims. This is usually the case when people with psychological disabilities are traumatized. Post-traumatic stress is much more severe, disabling and persistent with this population. Within 24 hours of his final "treatment" our son became unpredictably violent. He is now anxiety filled from day to night and cries frequently. He has flashbacks, intrusive memories, and nightmares. This formerly easygoing boy of four is now constantly fearful, easily startled, and lashes out automatically and defensively. His basic trust has been destroyed and he strongly avoids most people. In addition, he cannot even go near any educational materials or manipulatives (building blocks, etc.) without severe panic, since these were used in his behavioral program. These symptoms have proven to be very resilient despite our efforts to overcome them. We feel as if we lost our son that horrible day, to a program that on paper claims to use "positive practices" and "no aversives."

Parents, consider and research non-behavioral methods such as play therapy! The "recovery" we were promised for our son turned out to be an experimental, operationally defined term in the behavioral language. It is not really what we were led to believe by these ABA promoters, who are still experimenting on children.

ETHICAL VIOLATIONS OF PARENTS' RIGHT TO KNOW

Look for these ethical violations if you are or become involved with a behavioral program. The code numbers are taken from the American Psychological Association Ethical Principles of Psychologists and Code of Conduct.

1. The therapist states or insinuates that your child will/may "recover"using their method, without explaining the narrow definition of the term "recover" that was used in the 1987 Lovaas study on which they may be basing their statement and claims.

3.03 Avoidance of False or Deceptive Statements
Psychologists do not make public statements that are false, deceptive, misleading or fraudulent either because of what they state, convey, suggest, or because of what they omit.

2. The therapist does not give you the opportunity for INFORMED CONSENT.

4.02 Informed Consent to Therapy
Psychologists obtain appropriate informed consent...the person has been informed of significant information concerning the procedure (and)...has freely and without undue influence expressed consent and...consent has been appropriately documented. Anxiety disorders are just part and parcel of autism, common and unremarkable (there was no discussion of how this type of treatment may actually create an anxiety disorder in a child who does not already have one).

Our commentary: Informed consent should naturally consist of a risk/benefit analysis. We were not informed of any risks to this treatment, nor were the specific behavioral interventions to be employed named, described, or explained. On the contrary, every effort was made to avoid giving such significant information. The therapists avoided direct questions, said there wasn't time to explain, indirectly answered the questions, quickly changed the subject or simply shrugged their shoulders. We were given vague, non-scientific euphemisms for interventions and their results, such as "keeping him in his seat" (for physical restraint), "tantrums" (when he tried to convey his distress), and "He'll get over it." (when he began to show symptoms of PTSD). Even though we both have graduate degrees, the process of informing us was given at a 6th grade level.

In addition, efforts were made to get the objecting parent out of the therapy room, to further obscure informed consent. The objecting parent was verbally attacked and accused of self-interest, incompetence, and "getting in the way of the child's `recovery'." When his mother objected to her child's crying and when he was well over his head in anxiety, she was rudely and aggressively shouted at "not to interrupt the intervention!" Coercive persuasion was the hallmark of the particular program that harmed our son. We, as parents, were disregarded, talked over, talked down, ignored, corrected and directly insulted. The coercion was particularly strong when attempts were made to stop a demonstration of behavior modification that was doing obvious harm. Role reversal was also apparent such that we were talked to as if we were employees of this service providing organization rather than the reverse.

Restraint (e.g. demanding that the child stay in the seat no matter how much he tantrums) and its close interconnectedness to aversives were not described by the therapists. Restraint is probably the most dangerous thing that will be done to your child in the course of this therapy, and is what seriously injured our son. Later we found out that risks and "side effects" are common knowledge in the behaviorist community, but not at all in the parent community. The term "regression" was never spoken to us beforehand, and yet we were told later by a well-known professional in the behavioral field that it is common for children with autism to regress in ABA programs.

Rather than warn (through a process of getting our informed consent) that this type of treatment may make a child violent or anxiety-ridden, we were told:

+ If your child is not violent now, he will be later as a result of his autism.
+ If he strikes out "for no reason" you should have a neurological test done on him. (This sounds reasonable on the surface, but the context in which it was said and the defensiveness in the tone of voice belied what we now believe to be avoidance of attribution-- that is, an attempt to obscure the obvious reason for the child's actions.)
+ "Anxiety Disorder" is just part and parcel of autism, common and unremarkable. (There was no discussion of how this type of behavior modification program may be a potent trigger of anxiety in a child who is so vulnerable.)

3. The therapist purposively and without hesitation violates the generally accepted basic underpinnings of healthy child development and common sense.

1.04 Boundaries of competence
Psychologists provide services, teach, or conduct research in new areas or invoking new techniques only after first undertaking appropriate study, training, supervision, and/or consultation from persons who are competent in those areas or techniques.

Our commentary: We, as parents and as trained professionals in child development and psychology, posit that many in the behavioral establishment are unqualified to treat children with autism due to their lack of knowledge and training in human oriented disciplines, as opposed to the study of basic reflexes and animal behavior. Behaviorism's dangerous philosophical underpinnings still do not accord significant respect for the individual or recognize the sensitivity of people with disabilities, let alone the value and worth of every child's attempts to make sense of his or her world. Behaviorism does not respect the right of a child to express creative solutions to his world, despite the fact that this is the basis of his future ability to cope with novel situations and to carry that basic sense of security and self-confidence that is required of us all to become self-sufficient.

VIOLATIONS OF THE CHILD'S EMOTIONAL DEVELOPMENT

We found that the most dangerous outcome of the philosophical directives of behaviorism is violence to the sanctity of an individual's right to protect himself. This is what destroyed our child: he was denied the basic right to defend himself against unbearable anxiety. When he needed to get out of a situation he could neither understand nor bear, he was forcibly restrained and we were told, "All we're asking him to do is sit in a chair." His world was denied validation and treated as if it did not exist. His cries for help were ignored; "extinction" is the term. What was "extinguished" was not an isolated "tantrum" behavior but in fact our son's basic sense of security and safety, his ability to regulate his emotional system, and his understanding of moral behavior (i.e. that "when I'm hurting adults will help me").

Behaviorists deny the safety and importance of your child's emotions and treat them accordingly. For instance, when his mother objected to an intervention being described at a workshop, on the basis that our child would not understand the instructions being given him, she was told that "he will eventually." This is an answer that was of course inappropriate from the view of psychodynamic psychology or mainstream developmental psychology. The very nature of setting up a discrete trial training situation left our child crying and emotionally upset, due to the fact that everything our child was doing was constantly removed from the table and restarted. Blocks were his favorite toys, and he had always experienced great pleasure in mastery of them, so the constant interruption and dismantling of this play was experienced as extremely punitive. How could he be asked to demonstrate and enjoy his mastery, when someone else was taking control of the entire situation? We believe our son experienced this situation as "mystification," a term used by R.D. Laing to mean a confusion between inner and outer realities which requires a denial of one's own emotions. All our child's emotional reactions became reduced to one parameter: compliance or non-compliance, total willessness or tantrum behavior. The effect of such a reduction on a person's autonomy and initiative can be very negative. In this and similar ways our son's current level of damage, which is very severe, was preceded by less apparent levels of damage to his self-confidence and initiative.

It is well known among professionals who treat child abuse in families that one of the primary causes of child abuse is inappropriate developmental expectations. However, we were told more than once by the organization providing our son's behavioral treatment program that the goal was to get our son to act his chronological age. Therefore there would be implicit negative consequences (punishment) for being oneself -- that is, acting one's developmental age, which is like a biological imperative. The child must be his developmental age in order to maintain synchrony with his own emotions and understandings. Hence, insistence on things like "asking politely" (which couldn't possibly be understood by a child who is developmentally 18 months old, though chronologically 48 months old) becomes an inappropriate developmental expectation.

We believe it to be particularly destructive of a child's emotional development that hugs and kisses, gestures we normally use to express affection and love, are used instrumentally in many behavioral programs. The child is required to give and to receive these gestures as part of the training, without regard to his or her actual feelings. These "behaviors" will therefore come to have a different meaning for your child. Your child may develop obsessive-compulsive behavior in this area if he or she is in an ABA program that is similar to the one we had, since the meaning of a behavior comes out of the context it is most used in. Hugs and kisses, in the program we had, meant "I surrender (my project of autonomy, my understanding of my pain, my resistance to your will, my attempt to obtain freedom to pursue my intrinsic interest in this toy or manipulative)." They meant "I seek safety in this behavior" of performing the required hugs and kisses, because "I have learned that then the pain will stop (and so will my right to choose who will receive my affections)." Therefore one can no longer expect these "behaviors" to embody true expressions of love or affection given in freedom.

NEGATIVE IMPACTS OF OTHER BEHAVIORAL TECHNIQUES

During the course of our child's treatment, we noticed a number of other negative side effects to standard components of this ABA program:

1. Problematic Use of Primary Reinforcers
Our ABA program used basic and necessary components of everyday life as "primary reinforcers" for the therapy sessions, thereby confusing their meaning in their natural setting. For example, our child did not make a distinction between therapy sessions and eating with the family at the dinner table. Though he was proficient at feeding himself, when he became accustomed to having permission to eat in discrete trials, and to being fed as a reinforcer for "correct" behavior, he stopped his initiative at the dinner table. (We in turn stopped the use of primary reinforcers.) In its insistence on using eating as a reward, this program even took food out of children's mouths. We posit that the use of food in a way that makes it a conditional reward further compromises basic trust for the child and sets up the conditions for the development of eating disorders.

2. Emphasis on Parts vs. Wholes (e.g. flash cards vs. books)
Prior to the year we spent on our ABA program, our son had much interest in books and I would read to him a lot. After a short period of time doing the program, he lost interest in books and seemed to focus on one page as the task. He seemed to have lost his previous understanding of the flow of a book, which is not surprising since he was constantly drilled on meaningless parts of pages and on flash cards, in isolation from story lines.

3. Lack of Attention to the Development of Spontaneous Speech
We observed this ABA program's strong block to the development of spontaneous speech. Since most of the time was so totally structured, our child did not have time to think creatively and was not allowed to pursue his own interests. During the year we did discrete trial training, he did not use any of the speech he was trained in spontaneously. In fact, all his spontaneous speech and new speech came solely from interactions with us, his parents. New speech arose particularly from situations of play, when he was desiring fun, exploration, and novelty. Play therapy and speech therapy therefore appear much more efficacious than ABA, and are not dangerous. ABA did nothing but demonstrate a splinter skill: the ability to memorize words. Our child could do this before ABA.

4. Use of Restraint; Development of Anxiety
We observed the trainers sent to us use the chair in a punitive fashion. If our son was angry or did something they did not like, one of them stated, "O.K., back in the seat! Make him work!" This situation of being restrained or "in bondage" in the seat, in the sense that the child has no freedom of action and may even be in pain, is extremely anxiety-arousing and is exacerbated by the fact that the person in control of the child is a complete stranger. Even if there is a supposed safety valve (such as in the beginning months of ABA, when only 3 minutes in the seat is required at one time), when the situation is overwhelming and poorly understood anxiety can be cumulative over time. The body does not recognize distinctions such as "now I am out of the chair and I can completely relax and feel safe," and even when the child is out of the situation there can be residual pain, anxiety, and alarm from being repeatedly controlled, restrained, and manipulated.

5. Repercussions of "Extinction"
We have come to believe that the attempt to eliminate a targeted "behavior" by responding to it in a discouraging way (or not responding at all) is very dangerous. Keep in mind that what is being extinguished is not simply "a behavior": when this occurs with human beings, as opposed to the animal studies where the term originated, the process is much more complex. What is suppressed is "a choice," and that implies a deep internal restructuring of the child's understanding. If the behavior to be extinguished was his way of communicating distress, he may learn that he should not seek comfort when he hurts. He may learn that he should hide pain and somatize it (e.g. develop other symptoms such as stomach aches). He may conclude he is not loved. He might even become so alarmed that he develops symptoms of PTSD as our son did.

6. Significance of Regression Discounted
After the damage to our child, we were told by a well-known behaviorist that such total regression is common in children with autism. Yet the psychological texts we have seen find sudden major regression normally present in only a rare subtype of children with Pervasive Developmental Disorder, Rett's Syndrome. Could it be that sudden major regression is common in ABA programs rather than common in autism? We find this premise to be consistent with our training in depth psychology. According to Sigmund Freud, regression takes place in the face of acute trauma and overwhelming anxiety. We posit that behavioral modification can be a springboard to many serious maladies and maladjustments.

7. Sanctity of Home Violated
We believe that one of the primary reasons our son's PTSD is so severe and so persistent is that the assault on his body, in the form of restraint that was painful and terrifying, took place in the sanctity of his own home. Home is the place that must be safe, that must be the place of rest where we let down our guard, and must be the place where we feel protected. It is a fact that some of the most severe cases of PTSD occur when the assault took place in the victim's own home, because where there exists a deep expectation of safety it is most traumatic to have it suddenly violated.

8. Emotional Responses Dismissed
Calling all negative reactions "tantrums" is a dangerous reductionism which succeeds in lumping together all valid emotional reactions, totalizing them in one word, and prescribing extinction. We suppose that it could be said that our child was having a "tantrum" as his inner emotional system and autonomic nervous system were being torn apart.

Parents, we are writing this open letter so that you will have more information than we did on possible negative effects of ABA programs, of which we had been told nothing. We hope you will make a more informed decision after hearing the "other side."

May God Bless You.

This letter first appeared on the Children Injured By Restraint and Aversives support website.