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INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AAIDD

2016, Vol. 54, No. 5, 366376 DOI: 10.1352/1934-9556-54.5.366

The Reinforcement of Ableism: Normality, the Medical Model of


Disability, and Humanism in Applied Behavior Analysis and ASD
Eric Shyman

Abstract
The field of educating individuals with Autism Spectrum Disorder has ever been rife with
controversy regarding issues ranging from etiology and causation to effective intervention and
education options. One such basis for controversy has been between humanism, and humanistic
philosophical concepts, and its fundamental differences with behaviorism, and behavioristic
philosophical concepts. These differences have long been debated, and the belief that the two
orientations are generally mutually exclusive has been largely maintained. Recently, however, there
has been some resurgence of interest in reconciling some of the fundamental humanistic and
behavioristic tenets. Most of these discussions, however, center on specific interventional
methodologies as its basis without delving more deeply into the underlying philosophical issues.
This article will explore some fundamental humanistic concepts that ought to be reconciled in
order for behaviorism to be considered a humanistic practice. While the notion that the possibility
of reconciliation is maintained, the central argument maintains that much work needs to be done
on the part of behaviorism both philosophically and methodologically in order for such
reconciliation to be achieved.
Key Words: autism spectrum disorder; applied behavior analysis; inclusion; ableism

The field of educating individuals with Autism the medical model across many areas of social
Spectrum Disorder (ASD) has a rich history of science and human services, including the thera-
practical controversy, contradictory claims of peutic and educational fields (Fisher & Goodley,
dominant territoriality and effectiveness of inter- 2007). However, closer scrutiny reveals that there
vention, as well as competition for dominance over are a number of humanistic problems created when
the accepted conceptualization of the condition the centricity of the medical model of disability is
itself. One such interventional model, known most maintained by ABA in the area of educating
commonly as applied behavior analysis (ABA) or individuals with ASD.
intensive behavior therapy (IBT), among a variety For quite some time, there has been ongoing
of other monikers, is often argued to be the most debate regarding the relationship between human-
effective intervention for individuals with ASD ism and behaviorism, and a question as to whether
based on its ability to replace or reduce inappro- the two philosophical orientations are inherently
priate, non-contextual, or dysfunctional behaviors diametric. The basic critique of behaviorism, as
with those that are more appropriate, contextual, or regarded from a humanistic lens, suggests that
functional. Additionally, such interventions have behavioral methodologies are generally mechanis-
been claimed to be capable of progressing the tic, absolutist, symptom-focused, and oriented
individual with ASD toward, or in some cases even principally around external motivation (Hayes,
attaining, normal social and intellectual func- 2012; Ryan & Deci, 1996; Ryan & Deci, 2000).
tioning (Foxx, 2008; Howard, Stanislaw, Green, Humanistic approaches, rather, can be regarded as
Sparkman, & Cohen, 2014: Reichow, 2012). The more adaptable, person-centered, relativist, holis-
success of the ABA approach in attaining practical tic, and oriented around both internal and external
and clinical acclaim is unsurprising given the motivation (Buhler, 1971; Schneider, Pierson,
dominance of both the positivistic paradigm and Bugental, 2014).

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INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AAIDD
2016, Vol. 54, No. 5, 366376 DOI: 10.1352/1934-9556-54.5.366

Indeed, while there were some historical role in the discussion (Kapp, Gillespie-Lynch, Sher-
attempts at reconciling some of the seemingly man, & Hutman, 2013). While to a number of people
fundamental differences between humanism and neurodiversity is regarded as a misguided concept
behaviorism, many of these were generally dis- aimed at minimizing genuine struggles or over-
missed and relegated to the margins of the romanticizing the notion of acceptance, this radical
dominant mainstream discourse (Hayes, 2012). idea represents a positive step forward in the area of
While such issues and attempts at reconciliation humanistic thought at a greater social level, and calls
have experienced a resurgence over the last decade the medical models focus on intervention and
or so, especially through the increased research outcome directly into question.
presence of fields such as cognitive behavior
therapy (CBT) and acceptance and commitment Analytic Framework and Structure
therapy (ACT), to name but two examples, there
still exists a dearth of discussion that occurs between Because this argument is largely conceptual in
fields extending specific interventional practices nature, it is necessary to establish a framework
and focusing on deeper philosophical underpin- within which its foundations will be based. There
nings of those practices. are two main groundings for the argument:
Principal among the contemporary philosoph- disability studies in education (DSE) and critical
ical issues raised is the central role that normality discourse analysis (CDA). DSE, the general phil-
plays in the philosophy and practice of ABA. osophical framework for the argument can largely
Framed within the largely positivist and absolutist be framed as a perspective that regards disability
medical model of disability, maintaining an out- as a social phenomenon that interacts with the
come goal of attaining normality or some approx- educational environment in a number of culturally,
imation of it, in intellectual, social and/or socially, and politically relevant ways, essentially
behavioral functioning, is the main treatment goal, rejecting the medical model of disability. As such,
as such a model treats a condition such as ASD as a conceptualizations and arguments proffered from
medical problem that interferes with normal within a DSE framework are to be approached in a
functioning. However, a concerning by-product of pluralistic manner including social constructivist,
this type of approach is the propagation of the interpretivist, postmoderninst, poststructuralist,
dichotomous structure between normal and abnor- among others (Baglieri, Valle, Connor, & Gallagh-
mal, with abnormality being seen as both an er, 2011; Taylor, 2006).
undesired and potentially even tragic state. Con- CDA, the methodological framework em-
necting abnormality with ASD as its cause risks ployed interprets the specific use of language in
making tragic both the condition itself and, in a very research and theory within a social-theoretical
real sense, the individual who possesses it, relegating frame, especially involving notions of power,
the most effective and sensible therapies as those control, and dominance. Essentially, CDA employs
that will minimize, if not eliminate the autistic analysis of instances of social interaction in both
symptomatology, therefore bringing the individual linguistic and practical form, with especial regard to
closer to normality. An extension of this conceptu- the relationship between language and society, as
alization is the notion of ableism, or the idea that well as between the analysis itself and the practice
those who are more able are more includable being analyzed (Blommaert & Bulcaen, 2000).
into mainstream educational environments as well Therefore, in order to maintain fidelity to the CDA
as greater society. From this perspective, the goal of methodology, the current paper will intentionally
any therapy should be to increase ones chances at employ more frequent use of extended quotes
inclusion based on their ability to meet the despite such practice being generally avoided in
acceptable standards of normality. APA (6th edition) styled papers.
From a more humanistic vantage, the emerging While it is inaccurate and imprudent to suggest
concept of neurodiversity, or the idea that ASD that ABA/IBT is the sole methodological frame-
(among other potential neurological differences) is work for ASD intervention that employs the
overly-conceptualized as pathological by the medical medical model of disability as a fundamental
community, whose focus has become disproportion- (indeed, other approaches such as Defeat Autism
ate to the area of rehabilitation or even cure rather Now as well as many interventional projects within
than acceptance and value of diversity plays a central socio-developmental framework do as well), it is

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prudent to claim that it is the field whose advocates individuals should be required to receive treat-
tout its interventional capabilities and achieve- ment in order to ameliorate the consequences of
ments most boldly (Eikeseth, Smith, Jahr, & their disability. From the medical model perspec-
Eldevik, 2002; Eikeseth, Smith, Jahr, & Eldevik, tive, the locus of the disability itself lies within the
2007; Eldevik, Eikeseth, Jahr, & Smith, 2006; Fava person, leaving the need for treatment to come from
et al., 2011; Foxx, 2008; Howard et al., 2014; an external counteractive source. It follows, then,
Howard, Sparkman, Cohen, Green, & Stanislaw, that the focus of treatment from the medical model
2005). Therefore, the purpose of this article is to be perspective must be on either rehabilitating such
a contribution to the ongoing and ever-important difficulties that are caused by the disability or curing
contemporary discussion of humanism and behav- the individual of that disabling condition in order to
iorism, and is intended to evoke discussion and attain, or approach, normality (Areheart, 2008).
response from critical behaviorists who believe in Just under the surface of the disabled and
the necessity of such a dimension to the discourse, non-disabled dichotomy, then, is a deeper and
much of which has become unilaterally focused on more socially relevant dichotomy: that of normal
intervention and outcome at the expense of versus abnormal. Out of this conception emerges
philosophy. It is explicitly not intended as deni- a seemingly axiomatic version of what one ought
gration, or as an affront to behavior analysts as to be, able-minded and able-bodied, while any
practitioners, researchers, or philosophers. aberration from this standard is to be considered
This article will proffer the following argu- abnormal and disadvantageous, making treatment
ments: and rehabilitation of the utmost importance (Shy-
man, 2013).
1. The general framework of applied behavior The medical model, then, sets boundaries as to
analysis, including resulting therapeutic and who does the curing (and, ipso facto decides and
interventional methodologies, are generally designs the treatment regimen) and who needs
centered on the medical model of disability. the curing (or who receives the treatment),
2. Inherent to the medical model of disability is allowing for a hierarchical and potentially inequi-
the role of power between clinician/therapist/ table relationship between clinician/therapist/
teacher and patient/client/student. Fram- teacher and patient/individual/student. Suffused
ing applied behavior analysis and its resulting throughout the functioning of the medical model
methodologies within the context of power is the focus on a pathological orientation of
situates autism spectrum disorder (as well as thought: a perspective that seeks to isolate a set
those with ASD) as a form of enemy (as per of particular facts or indices of disability, usually
Broderick, 2010). in the form of definable physical or intellectual
3. The maintenance of the social metaphor of characteristics, which separates those for whom
ASD as enemy leads the greater field to normal functioning is attainable without treat-
address the efficacy of therapeutic treatment ment and those for whom it is not. The
of ASD in terms of achieving (or approaching) pathological model, then, is centered on the notion
normality. of diagnosis and categorization whose existence is
likely to lead to a particular type of treatment: one
that is best suited to rehabilitate, relieve, or even
The Medical Model and Pathological cure the individual of the ills caused by the
Orientation of Disability in Applied disability (or disease) (Hodge, 2005; Rogers &
Behavior Analysis Pilgrim, 2002).
This notion has received attention in the
The framework of social science regarding disability behavior analytic community historically. As Gold-
from the beginning of the 20th century has been iamond (1974) suggests in his now classic paper
conceptualized almost entirely within the medical Toward a Constructional Approach to Social Problems,
model. At its core, the medical model of disability is the pathological orientation is affected by both
centered on the dichotomous categories of dis- pessimistic views of abnormality and optimistic
abled and non-disabled in order to frame views of rehabilitation. Indicative of this frame-
acceptable levels of intellectual, behavioral, and work is the consequences that are apt to ensue from
social functioning, as well as determines which avoiding treatment for a pathological condition;

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INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AAIDD
2016, Vol. 54, No. 5, 366376 DOI: 10.1352/1934-9556-54.5.366

one that is likely to result only in crisis and requirements, and the ideologies and models
hopelessness for a once treatable but now largely which rationalize these behaviors and the
debilitating condition. contingencies of which they are a part now
It is squarely within this framework that ABA is seem invincible (p. 117-118).
situated, and from this perspective that both its
rhetorical and research basis is drawn. By regarding The emergence of Goldiamonds (1974) as well as
ASD as a pathological condition that stems from Wexlers (1973) arguments must be contextualized
particular neurological, biomedical and/or genetic within the true beginnings of behavior analytic
dysfunction, which results in both disabling and interventions, which were applied in more captive
abnormal behavior, the clinical goals (and, in many hospital or institutional settings in the 1950s and
cases, promises) of behavior analytic intervention 1960s. Accordingly, these authors suggest a number
build directly upon the notion of rehabilitating the of constitutional and ethical concerns regarding the
individual with ASD. Thus, this treatment can be increased use of what was then termed behavior
responsible for not only relieving him or her from modification, almost all of which remain relevant
the dysfunctional consequences of ASD (couched in today despite the widespread use of behavior analytic
terms of the behavior itself) but also delivering him approaches outside of such captive environments.
or her to having the ability to behave in a more The role of power between the therapist and
functional and normal, and thus socially acceptable the patient remains of central importance in
manner. It is the justification of the pathological such constitutional designs that are applied in
model that permits this frame of thought: without contingency-based arrangements. That is, behavior
intervention a pathological condition cannot be replacement and reduction plans center on the
rehabilitated or cured. By virtue of the fact that a implementation of reinforcement and punishment,
pathological condition is, in terms of cultural which is provided or withdrawn at the discretion of
definition, harmful, an intervention that has been the therapist. Indeed, though there is likely the
shown to be eliminative or at least reductive of such existence of an operational definition that guides
consequences is best suited for implementation. such decisions, the ultimate power of provision
remains in the hands of the therapist. Therefore,
The Role of the Medical Model of while the goal of treatment itself is clear and well-
Disability in Establishing ASD as suited to the methodology, the constitutionality,
humanistic value, and perhaps even ethicality of
Enemy the behavior replacement therapeutic process is
Maintaining the frame that ABA is centered on called earnestly into question.
the framework of the medical model of disability, it Therapeutic interactions such as those found
follows that a discussion of how the medical model in clinics, home-based therapeutic programs, and
is applied in the treatment environment (clinic, specific classrooms within schools (be they special-
classroom, or therapeutic home program) for ASD ized for students with ASD or programs within
is necessary. Endemic to the medical model is the greater public school systems and buildings) may
concept of power, and, more importantly, the role likely pose the same threats to a consensual
that power plays in an individuals, or a group of democratic system despite the elimination of
individuals ability to dictate what is to be regarded physical captivity. That is, through the application
as normal versus abnormal, and to ultimately enact of a behavioral contingency, an essential element of
intervention upon members of the populous who behavior analytic interventions, the treated must
appear to stray from this standard in order to evoke behave in a particular way or comply with a
normal behavior through any number of means. particular expectation in order to be given access to
According to Goldiamond (1974): a reinforcer (either self-chosen or compelled), or
reward for such compliance, doled by the therapist
. . .the idea whose time has come, that is, (or the treater) at the therapists discretion.
which begins to have social or scientific impact Through this system near-total (if not total) power
and to exert an influence over behavior which of the therapist is maintained. It is not necessarily
has hitherto been lacking, derives its onset of required that the individual consent to the
power from changes in social or scientific behavior plan in any way. (It is imperative to
contingencies. These exert new behavioral acknowledge that some plans for individuals who

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are able to consent are devised mutually and approach to dominate the policy and practice of an
methods such as person-centered planning attempt ever positivistic educational system. As Lakoff and
to extend this practice even to individuals with Johnson (2003, as cited by Broderick, 2010) suggest:
more severe communicative challenges). In such
situations of non-consent, if the clinical team Metaphors may create realities for us, especial-
deems the plan ethical and necessary it is not ly social realities. A metaphor may thus be a
required that consent be acquired from the guide for future action. Such actions will, of
individual under contingency, either to the plan course, fit the metaphor. This will, in turn,
itself or even the basic assumptions of the paradigm reinforce the power of the metaphor to make
from which the plan is derived; one which holds experience coherent. In this sense metaphors
their naturally chosen behaviors as inappropriate can be self-fulfilling prophecies (p. 156).
and dysfunctional and the synthetic replacement
behaviors decided by the clinical team as appro- Indeed, the positivistic notions of operational
priate and functional. At best, this can be seen as variables (those that are observable and measur-
passive consent, or assumed consent in the absence able) and its centricity in ABA play a dominant
of explicit dissent. Essentially, behavior analytic role in the visual power of such interventions. If
interventions may risk converting what may very one can literally see and measure an abnor-
well be rightful activities and provisions (such as mal behavior decrease and a normal behavior
access to recreation, food, and leisure activities) increase in its place, then from a strictly positivistic
into privileges to be earned based on compliance viewpoint there is little more evidence needed for
with a set of rules. such an approachs effectiveness. Not only is the
But for what reason should a social system phenomenon observable clinically and without the
derive a need to control something like ASD? A necessity of specialized training, but it is desirable
potential explanation lies in Brodericks (2010) socially, allowing the individual to progress toward
notion of ASD as enemy in which she states that normality. Thus, both the scientific and the social
both scientific and popular discourse has effectively metaphors are placated within one clear-cut
framed the function of autism in two threatening methodology. With the deep acceptance of the
ways: ASD as abductor and ASD as epidemic. Taken ASD as enemy metaphor, it would seem foolish,
together, these two functions warrant an urgent if not outright abusive for parents or caretakers to
response to eliminate, or at least minimize the choose away from an interventional modality that
symptomatology of ASD, allowing for the approach not only moves an individual toward normality, but
that does so in the most efficient and apparent can demonstrate its effectiveness in clear, quanti-
manner to gain dominance. Since, as it stands in the tative, positivistic terms.
current state of positivistic empirical research, there
is insufficient biological or neurological understand- Metaphorical Power of Applied Behavior
ing of ASD, at least enough in order to warrant a Analysis in Approaching or Attaining
clear psychopharmacological or biological treatment Normality
regimen, the mode of positivistic research that is
most highly associated with outcomes-based and The medical model of disability propagates a
normalizing evidence is ABA. powerful social and scientific narrative within
As demonstrated earlier in the argument, the which one is to regard ASD as a disease, indeed,
framework of ABA is a well-suited fit for the an enemy, that is to be treated or even cured in
medical model of disability. Therefore, it stands to order to provide a basis for a person to attain
reason that it would also be a well-suited fit for the normality. By situating ASD in this way, the
medical-model based approach for treatment cen- powerful rhetorical tool of treatment as reha-
tering on eliminating the symptoms of ASD and bilitation or even cure becomes an obvious end
allowing momentum of the individual toward goal. This sentiment is quite powerfully demon-
normality. Because both the methodological frame- strated in the philosophical and rhetorical under-
work of ABA fits the medical model of disability in pinnings of ABA as a treatment for ASD. One of
terms of treatment, and the philosophical perspec- the most demonstrative instances of this perspec-
tive of ABA fits the social and cultural metaphor of tive was a catalyzing article in the Summer 2002
ASD as enemy, it follows that it has become the newsletter of the Association for Science in Autism

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Treatment (ASAT), a largely behaviorally-based analogy and reinforce the autism as enemy
organization, in which Catherine Maurice, a metaphor, likening its existence to cancer. That
mother of two children with autism and author of is, if ABA is to ASD what chemotherapy is to
the now canonized book Let Me Hear Your Voice cancer, the connection, especially by emotionally
(1994) proposes that the purpose of treatment for vulnerable parents seeking help for their child will
individuals with ASD should be, ultimately, cure, play a significant role in buy-in. This perspective
but in the absence of such possibility the goal then is not unlike that critiqued by Sontag (1978) in her
becomes to . . .maximize the patients potential catalyzing book Illness as Metaphor. However, to
(Maurice, 2002, p. 3). In a bolder modality of truly compare the nature of ABA research and
thinking and employing a highly powerful meta- practice with that of cancer pushes both rhetorical
phor, Maurice then analogizes ABA as a treatment and ethical bounds.
for ASD to chemotherapy as a treatment for What is legitimately implied by Maurices
cancer. As she suggests: statements, however, is the deep notion that is
undoubtedly (and understandably) shared by many
Just substitute the word cancer for autism parents and other stakeholders involved with
and any lay person could detect a slightly individuals with ASD: that the goal for any
subversive note: Are there ethical issues treatment should be a reduction in disabling
associated with recovery from cancer? What behaviors (those that are symptomatic of ASD)
is the economic implication of wide scale and an increase in functional behaviors (those
attempts to recover people from cancer?...Why that allow the individual with ASD act less
would we not attempt to recover anyone from autistic and more normal). As a result, the
cancer, or autism? No, we cannot guarantee preponderance of studies that have been used to
[italics in original] cure for anyone, but is that evidence the effectiveness of ABA as a treatment
sufficient reason to lower the bar? Do we start for ASD grounds its claims squarely within the
deciding how many people should have access context of normalization and, in other extreme
to science-based treatments to cancer? Do we cases, recovery. Indeed, this goal is explicitly
start deciding how many children should have stated in a guidance document by the Behavior
access to ABA? (p. 4) Analyst Certification Board (BACB, 2012), which
is the governing body of credentialing behavior
While there are multiple problems with the analysts. This document states that . . .the goal of
underlying logic, as well as the veracity of this line treatment is to bring the clients functioning to
of reasoning, the most evident problem is the levels typical for that chronological age or
comparison itself between ASD and cancer. Cancer maximize independence in multiple areas (p.
is a biologically based, definitively diagnosable 23). While there is no humanistic or philosophical
disease, which can be legitimately recovered from issue with working toward independence in
once cancer cells are no longer present in the body. multiple areas for an individual with a variety of
Attaining quantitative measures to validate the challenges, the problem is encountered in the
absence of cancer can be facilitated through context of typicality and normality.
medically-based and largely trustworthy tests. The likely root of the connection between
ASD, conversely, while widely thought to be behavior analytic approaches and the attainment of
biological and neurological in nature based on normality can be traced to a seminal but significant
strong emerging research from various fields, study published by Lovaas (1987), which is
cannot be definitively biologically identified or generally regarded as the first systematic study of
measured. The diagnosis and existence of ASD is, the application of behavior analytic principles in
and has always been, diagnosed as a means of the intervention for children with ASD. Attempt-
behavioral interpretation based on clinical best ing to contextualize his results as clinically
estimate: that is, a qualified clinicians best significant Lovaas (1987) claims:
judgment based on a variety of imperfect and
questionably suited behavioral assessments (Lord et This article reports the results of intensive
al., 2006). The comparison, then, between chemo- behavioral treatment for young autistic children.
therapy and ABA serves only a rhetorical function Pretreatment measures revealed no significant
to enhance the scientific credibility of ABA by differences between the intensively treated

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experimental group and the minimally treated decades (Foxx, 2008; McEachin, Smith, & Lovaas,
control groups. At follow-up, experimental group 1993; Howard et al., 2014; Peters-Scheffer, Didden,
subjects did significantly better than control Korzilius, & Sturmey, 2011; Sallows & Graupner,
group subjects. For example, 47% of the 2005; Smith & Lovaas, 1988; Smith, Eikeseth,
experimental group achieved normal intellectual Klevstrand, & Lovaas, 1997; Smith, 1999).
and educational functioning in contrast to only Indeed, the contextualization of attaining nor-
2% of the control group subjects (p. 3). mality as a goal for intervention may seem innocuous,
if not entirely sensible at face value. Why would a
Though hailed by many in the growing field of parent, clinician, or even individual with ASD not
behavior analysis, Lovaas bold claims did not go want to gain ground toward being normal when
undisputed by many others in the field of ASD (see normality is the standard of acceptance in a society?
particularly Schopler, 1987). The harm of such a perspective is revealed, however,
Despite the critical reception by many notable by the tacit diametric though simultaneous message.
researchers, the notion that behavior analytic The first danger is the language of deficit that is
intervention can lead to recovery, cure, or at carefully employed by such conceptualizations of
least approximations of normality for children ASD. Endemic in the vast majority of the behavioral
with ASD became an indelible part of the behavior studies cited, whether explicitly stated or not, is an
analytic narrative, and continues to play a deeply acceptance of the legitimacy of the medical model of
important role in the appeal and adaptation of disability as applied to ASD. That is, that ASD as a
behavior analytic interventions for children with condition, as well as its symptoms are negative and
ASD. This idea can be evidenced by the propaga- denigrating, and must be treated and reduced in order
tion of such claims over the last several decades to increase ones quality of life. Though this is, to be
since Lovaas (1987). According to Jacobson, sure, a widely accepted, if not axiomatic frame of
Mulick, and Green (1998): thought in behavior analytic research (as well as
greater positivistic medical research), it has not, in
Research indicates that with early, intensive any way, been validated or even suggested by
intervention based on the principles of applied quantitative or qualitative research. Therefore, it
behavior analysis, substantial numbers of cannot be seen, by any standards of veracity, as a
children with autism or PDD-NOS can attain point of fact, but rather a widely accepted though
intellectual, academic, communication, social, potentially erroneous presumption that has grown out
and daily living skills within the normal range of the medical model of disability.
(p. 201). The message of this line of thinking is clear:
the more normal students become (as evidenced, in
Harris and Delmolino (2002) similarly suggests: a large way, by whether they qualify for general
education placement), the more effective and
The techniques of applied behavior analysis valuable a treatment is (and therefore, worthy of
(ABA) are effective in altering the develop- monetary investment) (Chasson, Harris, & Neely,
mental trajectory of some very young children 2007; Jacobson et al., 1998). This is also,
with autism. This research suggests that early, essentially, the message of the medical model.
intensive treatment using the methods of ABA Parents and caregivers are then faced with a choice:
enables a significant number of children to they can choose an intervention methodology
enter the educational mainstream and achieve that is most likely to maximize an individuals
normal intellectual functioning (p. 11). mobility toward normality (in which there is
hope) as supported by science (comprising
Reichow (2012) suggests, based on his overview of both the dominant social and medical message) or
meta-analyses that [Early Intensive Behavioral they can choose less evidence-based (or, in some
Intervention] can be a powerful intervention cases unproven) intervention methodologies that
capable of producing large gains in IQ and/or do not. When distilled, this choice, adamantly
adaptive behavior for many young children with proclaimed by proponents of the field of ABA,
ASDs. (p. 517). While these claims represent only amounts to not only choosing effectiveness over
a sample, there is a rich history of similar claims ineffectiveness, or real science over faith, but
evident in the extant literature over the last three choosing hope versus hopelessness.

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It is thus argued that ABA, through the Broderick (2009) sets ABA squarely within this
scientific lens of humanistically decontextualized framework by suggesting:
outcomes-based evidence-basis, harnesses a power-
ful rhetorical device by offering parents not a choice In the context of the ongoing reproduction of
between a happy child or an unhappy child, but ABA discourse. . .as inherently tragic, cata-
rather a hopeless abnormal child, or a hopeful strophic, and hopelessthe concept of hope
normal one. As a result, the legitimacy of the for recovery stands in stark contrast to this
medical model of disability is both preserved and dominant picture of hopelessness and despair
propagated, situated squarely as the frame upon and is presented as the only hopeful vision
which parents are implored to make decisions about available, or at least, as the only real hope
the treatment of their children. From the [italics added]. Recovery thus becomes almost
behavior analytic perspective, such decisions must synonymous with hope itselfin the apparent
not be based on emotional thinking, clearly absence of other visions of hope, hope for
connoted as unclear and unsound from a positiv- recovery may be welcomed by those who insist
istic perspective, but rather on systematic, objec- on embracing hopeful visions of futures for
tive, and scientific decision-making. As Catherine young children labeled with autism in spite of
Maurice (1993) suggests in Let Me Hear Your Voice: the dire prognoses traditionally offered (p. 271).

After gamely agreeing to look at beloved works This characterization leads one to the conclusion
of poetry and fiction through the diverse lenses that absolutism is not only the epistemological
of structuralism, poststructuralism, phenome- frame within which ABA is situated, but the very
nology, feminist criticism, deconstruction, I means by which its claims can (and should) be
pounced on medicine like some poor fact- substantiated. When one can see their child
starved rat. I was tired of truth as a relative progress toward normality by replacing their
term, a shift of ones perspective, a way of asocial or dysfunctional behavior with pro-
seeing. Information was what I wanted to try social or functional behavior, the promise of
on for size. Science. A corpus of knowledge hope itself is reinforced, and with human percep-
validated by whether its data held together tion favoring linear organization and sensory-based
empirically, not by whether its practitioners evidence, the caregiver becomes convinced of the
had the gift of gab (p. 16). effectiveness of an intervention that can quite
literally be demonstrated to minimize (or elim-
Clearly Maurice is suggesting that emotional input inate) that which is autistic and replacing it with
into clinical decision making serves not only a that which is normal. With this replacement
distracting, but more so a destructive purpose that come also all of its social trappings, such as
disallows parents and caregivers to make clear qualifying for more inclusive educational envi-
decisions based on fact while they are bamboozled ronments, participation in mainstream society, and
by their own emotional investments and lack of a more acceptable form of a social life. As Fitch
rational clarity, thus needing to rely on the more (2010) explains:
objective and less emotionally invested clinical
professionals (an analogous outplay of the power This practice, grounded in scientific positivist
dynamic demonstrated previously). Essentially, assumptions and the biomedical model of
Maurice implies that what one regards emotionally disability, continues to legitimate segregation
as hope can really be best defined as a craving for and inequality and justify a dual system of
rational thinking and action. According to Dan- special education. Demonstrating the socially
forth (1997): constructed nature of difference/deviance,
labeling deviance theory has played a crucial
From this [modernist] perspective, hope lies in role in challenging this orientation, serving as
the gradual, scientific production of improved one of the key conceptual foundations for the
approximations of truth and the develop- disability and inclusive movements. (p. 18).
ment of intervention technologies, practices,
programs, and instruments that work ac- It is upon this foundation that the concept of ableism
cording to the truth-clarifying research (p. 94). is directly reinforced by not only the medical model

E. Shyman 373
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2016, Vol. 54, No. 5, 366376 DOI: 10.1352/1934-9556-54.5.366

of disability in general, but the preoccupation with in the area of disability studies in education
ABA for individuals with ASD. specifically suggest rethinking this dichotomous
It is important to add, however, that there are approach. Third, the inclusion of the notion of
counter-narratives present from parents which neurodiversity as a component to humanistic func-
demonstrate a clear rejection of the notion of tioning needs to be further explored and analyzed,
regarding the attainment of normality as the especially given how such a concept applies to
optimal result for intervention, or for their children individuals with varying degrees of severity. Finally,
to begin with. But one example is from Kephart the field of ABA has, indeed become more nuanced,
(1998) who relates: and the means by which different methodologies that
fall under the auspice of ABA address these particular
What, in the end, are you fighting for: Normal? humanistic issues (such as pivotal response training,
Is normal possible? Can it be defined? Is it best positive behavior support and person-centered plan-
achieved by holding up in the offices of ning) must be more deliberately addressed.
therapists, in special classrooms, in isolated Ultimately, however, it is suggested that the
exercises, in simulating living, while everyday current argument revealed some important philo-
normal happens casually on the other side of sophical humanistic issues that must be addressed
the wall? AND is normal superior to what the by critical members of the field of ABA should any
child inherently is, to what he aspires to, fights such reconciliation with humanism be accom-
to become, every second of his day? Normal in plished. There is, indeed, a deep possibility for
terms of what, and by what sacrifice? (p. 11) humanistic behavioral approaches that are as strong
in outcome as they are humanistic in approach,
though earnest conversation only will fully provide
Limitations of the Argument, Future means. It is hoped that this piece provides some
Directions, and Conclusion productive contribution to this discourse.
The current argument aimed to contribute to the
resurgent dialogue regarding the differences between
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Oaks, CA: Sage Publications. Patchogue, NY 11772 (e-mail: eshyman@sjcny.edu).

376 Applied Behavior Analysis and Humanism for ASD

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