Letter from Catherine Maurice, PhD. Author

Thursday, May 18, 2006

What a disservice to children and families. One method, which has been shown through controlled research to consistently improve the outcomes for children with autism, is painted with the standard clichés of cold, manipulative, robot training; the other, which has been hugely marketed and promoted, is depicted in glowing terms as caring, compassionate, addressing the whole child instead of the symptoms, etc. Who wouldn’t want to place their child in the loving embrace of Floor Time, as opposed to the ABAprogram, which is depicted as something close to dog training obedience school?

These biased distortions about ABA have been around ever since two of my three children were diagnosed with autism. Fortunately, we were able to figure out the truth for ourselves, through trial and error, about which approach has a track record and which have none to speak of. Today, both children are fully mainstreamed, one a sophomore in college, the other accepted to begin his studies at a major university. That outcome is one of several possibilities. Other children, even those who receive high quality intervention, will make more modest gains; the field of ABA has never claimed that it will rescue all children from autism. It does however, have the evidence to show that if it is administered well, by competent, highly trained people, it has the capacity to bring about improved functioning, greater communication, enriched social interactions, and a more independent life for the majority of children diagnosed with autism.

What is the track record behind Floor Time? Where is the published and peer reviewed research showing the success, or even effectiveness, of this approach, in alleviating any of the severe and debilitating symptoms of autism? How many years has it been around, and how long must the public wait for that corroborating evidence – always promised, never delivered? Why is this approach being so aggressively promoted and marketed? Of course play and caring and fun and joy and compassion must be part of any approach to autism. But if playful nurturing and caring could rescue children from autism and teach them language, we wouldn’t really need either Floor Time or ABA, would we? Any loving Kindergarten teacher who knew how to structure a nice stimulating, enriching classroom with lots of play and attempts at “relating” could do the trick. Unfortunately, autism demands a much more focused, empirically-validated approach.

The almost total disregard in this article of small matters like outcome, data and evidence is bad enough. More troubling, however is the implicit accusation that by placing their children in an ABA program parents and therapists are somehow ignoring a child’s emotional life. How offensive, both to parents who have chosen ABA and to the therapists who work so hard with their children. The behavioral therapists that I have known, including Bridget Taylor, featured in your article, are filled with loving enthusiasm and a keen respect for every aspect of our children’s development, from language, to play, to social interaction, to academics. The families I have known over the years who have chosen an ABA approach are every bit as concerned with their children’s hearts and souls as with their behaviors or their academics. Only marketing hype for fad treatments, supported by media sensationalism, would insist otherwise.

Bettelheim was the first to accuse parents of emotional distance and to excoriate behavioral treatment as “treating the symptoms” and not the “root cause.” How many times since that era of “refrigerator mothers” have we heard this tired old mantra? So many people claim to have found the “root cause” of autism, and so many fads and marvelous, warm, caring, humane treatments abound, supposedly to “fix” that root cause, it’s a wonder there is any autism left on the planet. It’s difficult to understand why the editors of Time seems so unaware of this historical context, this language of false promises, over-marketed treatments for autism, and pontifications about root causes. But unaware you are. Worse, you have chosen to propagate one of Bettelheim’s favorite themes: That parents who have chosen applied behavior analysis just want “obedient” children who “look normal.” Perhaps Time should interview a host of parents who did choose behavioral therapy to find out the truth of their hopes and dreams for their children. Those hopes and dreams tend to revolve around the happiness of their child, not his “perfection.” No parent that I have known, in my twenty years of autism advocacy, simply ignores their child’s emotional life in pursuit of conditioned behaviors. That cruel caricature is just a reprieve of clichés that have been around for decades, clichés that we have been struggling to overcome, in order to assure effective treatment for all children diagnosed with autism. The way toward empirically validated treatments, backed by research and proved effective over multiple trials and in multiple studies, has been long, and hard, and the battle is by no means won. Today, parents who choose ABA are excoriated right and left, from those who paint them as ignoring their child’s emotional life to those extremists who deride and harass them for “rejecting” their child because he is not “normal.” In reviving all the tired stereotypes about ABA, you have done such a disservice to children, you have prolonged the endless struggle to access effective treatment, and you have levied yet more insult on parents who struggle everyday to help their children reach their fullest potential.

Catherine Maurice, PhD