Red Flags of Early Intervention for Autism

“Quiet hands” is a common stim suppression technique used in some early interventions such as Applied Behavioral Analysis (ABA).

After children are given an autism diagnosis, their parents are often recommended early intervention services, such as occupational therapy, speech therapy, and Applied Behavior Analysis (ABA). Some of these services can provide benefits for developing neurodivergent minds, such as sensory integration and motor skill acquisition that occupation therapy provides, and speech therapy and communication skills from a speech and language pathologist. However, other early intervention services, such as ABA, don’t focus on accommodating and supporting a neurodivergent mind as much as they do trying to reshape it into a neurotypical mind.

Autistic people who received ABA therapy as a child have compared it to gay conversion therapy. Just as gay conversion therapy attempts to convert LGBTQIA+ people into heterosexual people by repressing their sexuality, ABA uses compliance techniques and suppresses autistic behaviors to convert autistic and neurodiverse children into neurotypical children. ABA can be damaging for young autistic children, some as young as three, four, five years old, who endure forty hours of ABA per week, as much as a full time job. Additionally, ABA can cause psychological damage, including PTSD in autistic adults, and teaches strict obedience and compliance, which can prone young autistic children for abuse as a teenager and adult.

The problem is, some early intervention services may not outright say if they use ABA techniques or not. Sometimes, ABA can be combined with other services such as speech therapy, occupational therapy or social skills classes. If you are unsure if the early intervention service you chose for your autistic child is harmful or is implementing ABA techniques, here are some red flags of ABA to look out for:

“Quiet hands” and other stim suppression techniques

ABA teaches autistic children what is “appropriate” social behavior by teaching practices such as quiet hands, which rewards autistic children if they don’t stim with their hands or if they don’t visibly or vocally stim. ABA gives rewards for desired behaviors, such as eye contact and keeping still, and gives out punishments for undesirable behaviors, such as stimming. If you hear your therapist say, “Quiet hands,” “table ready,” “Look up here,” or, “Eyes on me,” and punish behaviors such as toe walking, hand flapping, echolalia, or any other forms of stimming, or other “quirks,” these are some red flags.

Suppressing emotions

ABA therapists reward autistic children for being compliant and happy, and punish autistic children when they feel frustrated, upset, angry, or have a meltdown or shutdown. This teaches autistic children that expressing emotions other than happiness is not okay, which is very damaging to teach young, impressionable minds.

Harsh Punishments

ABA is based on a system of rewards for desired behaviors and punishments for undesired behaviors. The nature of punishments in ABA can be severe for autistic children. They can range in comfort objects or favorite foods being taken away, to being restrained, scolded or yelled at, or given a “time out” for not achieving a desired result. If you see any of these punishments being dealt out that distress your autistic child, this is a big red flag.

A noticeable increase of meltdowns and shutdowns after the early intervention

If an autistic child shows stress and anxiety arriving to the early intervention, or has an increase of meltdowns and shutdowns after the early intervention, it is likely that the early intervention is causing severe distress and they should be taken out immediately.

Push for progress and get upset if progress is not met by a certain date

ABA tends to focus more on the progress than the person. While a good early intervention service would allow an autistic person to develop life skills at their own pace, ABA wants to achieve behavioral progress and remove certain autistic behaviors by a certain time frame.

Changing behaviors that don’t need to be changed

Unless behaviors that autistic people exhibit are damaging themselves and/or others, they do not need to be changed, and shouldn’t be changed. If the early intervention therapy seeks to change the way an autistic person plays with their toys or colors a picture, then this is a red flag that the early intervention might remove other autistic behaviors such as stimming.

Requesting alone time with the autistic person

If the early intervention requests strict one on one time with the autistic child without the parent watching the therapist and holding them accountable, this is a big red flag. If you are a parent, do NOT proceed with the early intervention if the therapist requests to work with your child without your presence.   

Lack of respect for boundaries

If the early intervention forces autistic children into social greetings that they are uncomfortable with, such as giving them hugs if they don’t like to be touched, this is a red flag that they will not respect other boundaries, such as promoting unwanted social interaction. Sometimes, autistic children may not want to socialize and would rather be left alone, and ABA might force autistic children into pretend play scenarios that they are uncomfortable with. Consent is a very important thing for everyone to learn at a young age, and if the early intervention therapist does not respect physical and social boundaries, this is a big red flag.

So, is there such a thing as “good” early intervention services that don’t involve ABA? There are, but they can be difficult to find. Remember that good early intervention services will:

Teach life skills, motor skills, and communication skills at an autistic person’s own pace, and prioritize their happiness and well being over progress.

Rather than giving a timeline for achieving desired results or making desired progress, good early intervention services will ensure that the autistic person they are working with enjoys being there and is free to express themselves. They work with the autistic person at their own pace rather than giving deadlines to parents for achieving certain skills or removing autistic behaviors and that there is no one definition of “progress” as every autistic person has different needs and abilities. They also teach skills that are helpful to an autistic person, such as motor skills and communication skills, rather than teaching behaviors that are unnecessary, such as forcing eye contact or teaching superficial communication such as “mommy” in lieu of words that are more necessary such as “hungry” and “stop.”

Teach an autistic person how to cope and self-regulate in stressful environments rather than putting them through a stressful environment by making them act neurotypical.

Rather than taking away or punishing stims, good early intervention services will encourage stimming and will accommodate autistic people, such as recommending noise cancelling headphones if an autistic person covers their ears a lot or polarized lenses if they constantly squint at bright lights, which can both indicate sensory sensitivities.

Teach autistic people how to express their emotions, and that their feelings, including ones of anger, sadness, and confusion, are valid.

Rather than punishing autistic children for having a meltdown or for “acting up,” a good therapist will teach them that it is okay to feel upset or angry and will allow them to take the time they need to self-regulate. They also teach calming activities they can do if they do feel upset, such as enjoying a special interest, or using a stim object. Good early intervention services may teach social skills such as how to make friends, but they also teach skills to help them get what they want and prevent others from taking advantage of them, such as assertiveness.

Presume competence and not treat autistic people like they can’t understand what they are saying to them.

Rather than therapists talking down to or infantilizing autistic children and adolescents by using baby talk or talking in third-person while an autistic person is present with them, good therapists will presume competence, which means they presume that the autistic person they are working with them can understand them, even if they may not give vocal or social cues as indicators. Presuming competence means talking to and treating autistic people no differently than same-aged neurotypical people.

Allow autistic people to stim: Flappy hands are happy hands!

A good early intervention provider will allow autistic people to stim however they like rather than teaching them to conform to social norms and mask their autistic behaviors. They do not use “quiet hands” and sometimes, can even stim with them (in a way that’s not mocking any stimming but encouraging it, such as through a stim dance party!) Helping autistic people find comfortable stims rather than banning stimming will help them to better self-regulate in overwhelming sensory environments.

Accommodate the various ways autistic people communicate and prioritize communication over acquiring verbal speech.

Communication is not just speech. Some autistic people communicate through other means such as sign language, picture cards, through an iPad or tablet, and through other AAC devices. A good early intervention provider will not take these means of communication away or limit them in favor of verbal speech, but will accommodate the way that the autistic person communicates.

Allow autistic people to take breaks so they don’t feel overwhelmed with tasks.

ABA providers often highlight how essential it is for young autistic children to have hours upon hours of repetitive tasks to “fix” or “correct” their behaviors. But good early intervention providers do not force autistic people into doing anything they are uncomfortable with, and allow them to take breaks and come back to activities when they feel like doing so. Some early service providers may even have a sensory room with objects such as swings and punching bags, which can help autistic people release frustration in constructive ways and can help fulfill an autistic person’s sensory needs.

It is often said how essential early intervention is, and parents are told to immediately seek early intervention after their child has been diagnosed with autism. Before immediately taking the recommendation to go to ABA, try to seek the opinion of an autistic adult, either online or in person, who has been through early intervention services to see what has benefited them and what has harmed them. If you have placed your autistic child in an early intervention service and you notice any of the red flags, take them out and don’t turn back! Explicitly ask the early intervention service provider if they do use ABA techniques. If they say yes, hang up the phone!

Prior to committing to any early intervention service, evaluate if it will really benefit your autistic child and what the goals of the early intervention are. Do the goals include compliance based techniques that force social masking around others? Or do the goals help autistic people to become more independent and help them to express themselves and self-regulate? This difference could possibly be the difference between an autistic adult who feels they have to socially mask and hide their autism to be “functional” in society, and an autistic adult who accepts themselves for who they are.

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One thought on “Red Flags of Early Intervention for Autism

  1. Thank you for this informative article. I feel quite confused about the conflicting reports about ABA. My Son is autistic , I am neurotypical. I am in Australia and I wonder if the way ABA has developed here is different to the US or the UK.

    My son participates in ABA therapy. He does 2 x 1.5 hour sessions a week, and the therapy looks a lot more like green ticks described above and NOT the red flags. There are repeated tasks, from which data us processed and analysed monthly, which sounds like ABA but our goals are emotional regulation, empowering our son with tools to better engage with language and effective communicate to others. His stims are not prohibited, and he has regular breaks throughout the 1.5 hour sessions which can be at a a table, in the yard, on the floor playing a game… all
    Whilst specific goals are being targeted and data taken. His therapists are kind, courteous and always focus on choice and natural consequences not punishments. He is never punished for being frustrated or melting down. He is given space, and communicated gently with. We also focus on how behaviour is functional and try to work out why certain behaviours may be occurring rather than trying to simply suppress them.

    I have no doubt that ABA has been done in a fashion that has been extremely harmful and I believe what Autistic adults say about their experience without reservation. I just wonder if what we are doing with our son is even in the same category. Sometimes I wonder if I am damaging him from these reports , yet what we’ve been doing sounds very different to any of the red flags above. Still of course I am open and always want to know more and be aware, so your thoughts would be greatly appreciated.

    Like

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