This behavior therapy may be evidence-based, but a growing movement is questioning its aims
STUDY: Mathur SK et al, Behavior Analysis in Practice 2026
STUDY TYPE: Discussion and review paper
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.
The Study
- The researchers are based in California and England. One of the CAS scholars had completed behavior technician.
- ABA scholars posed nine questions to the CAS scholars, who answered in writing and then met via video conference for unscripted discussion.
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.
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 deserve scrutiny. The autistic adults surveyed in a companion study rated those latter goals as “never” or “very low priority.”
- “Be on the outside who you are on the inside.” Someone once wrote that was the goal of psychoanalysis. Was it Carl Rogers? Donald Winnicott?
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
