In 1965, a Life Magazine photo essay documented the sometimes harsh approaches employed by ABA therapy
This behavior therapy may be evidence-based, but a growing movement is questioning its aims
STUDIES: Three discussions from Behavior Analysis in Practice, June 2026: Mathur SK et al, McComas JJ et al Beginners Guide, McComas JJ et al Historical Context.
FUNDING: SCELC, Statewide California Electronic Library Consortium
Background
Applied behavior analysis (ABA) has faced growing criticism from autistic self-advocates and the neurodiversity movement. Critics argue that ABA has historically aimed to make autistic people appear “normal,” suppressing natural autistic behaviors like stimming and avoiding eye contact, and centered neurotypical goals rather than autistic well-being.
This journal featured a dialogue between two ABA and two Critical Autism Studies (CAS) experts, exploring how the two fields could move forward together.
Results
The CAS scholars did not call for abolishing ABA. Instead, they argued that ABA’s core principles apply across all neurotypes. A neurodiversity-affirming ABA is possible, but would require meaningful changes.
Their sharpest critique: 82% of certified behavior analysts work with autistic people, yet most ABA training programs teach nothing about autism beyond basic diagnostic criteria. The CAS scholars called this a fundamental error. You can’t do autism-centered work without understanding autism from the inside.
Other key points from the CAS scholars:
- Some symptoms ABA treats as “problem behaviors” are simply autistic ways of being. Stimming may calm or focus the individual; avoiding eye contact may help them integrate verbal and visual information.
- The field has focused on measuring what’s easy to measure (e.g., reduced stimming) rather than what matters: whether autistic people’s lives and well-being improve over time.
- There is no validated measure of autistic well-being. Developing one requires fully funded, co-produced research with autistic scholars.
- ABA should stop claiming it is the only evidence-based therapy for autism, and engage collaboratively with speech therapists, occupational therapists, psychiatrists, and psychologists.
The CAS scholars also flagged the lack of long-term outcome data, and cautioned about potential links between ABA exposure and PTSD symptoms.
Their top recommendation: teach practitioners to consider modifying the environment before assuming the autistic client’s behavior needs to change.
Historical Context
Applied behavior analysis emerged in the 1960s alongside the disability rights movement, when behavior analysts applied scientific principles to help people living in inhumane institutional conditions. Early targets were severe behaviors: self-injury, aggression, extreme social withdrawal. The work was genuinely useful. Lovaas’s 1987 landmark study showed that intensive ABA improved communication and reduced self-injurious behavior in autistic children.
But the methods were often harsh. A 1965 Life magazine article described Lovaas administering electric shocks to an autistic girl named Pamela for “drifting off” during lessons; essentially, for stimming. The article treated this as progress.
The field’s ableism wasn’t always this blatant. More often it operated through assumptions: that autistic behavior was deficient by definition, that the goal was to make autistic people appear “normal,” and that non-autistic parents, teachers, and clinicians were best placed to define success. Autistic people’s own preferences and priorities were rarely consulted.
The 1990s brought insurance mandates, rapid growth in certified practitioners, and private equity investment. The ABA industry now generates at least $4 billion annually. Growth brought access, and new pressures that sometimes placed profit ahead of individualized, person-centered care.
Practice Implications
- The dialogue has implications for how we think about all psychiatric disorders. What are the treatment goals, and who chooses them?
- For autism, goals centered on expanding communication, self-advocacy, and quality of life have strong face validity. Goals centered on eliminating eye gaze avoidance or reducing stimming, less so.
- The tension here plays out in psychotherapy beyond autism. As Benjamin Kovitz put it t, “You serve [patients] best, not by siding with patients against the world or with the world against the patients, but by helping them to coexist.”
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
