Part IV of IN A DIFFERENT KEY is about ABA. Like the other topics handled in the book prior to Part IV, the authors take a sympathetic approach to the topic.
(Note: If you find ABA to be a triggering topic – as many autistic people subjected to it do – you may wish to stop reading here.)
The authors’ sympathetic approach begins with their sympathetic portrayal of Ivar Lovaas, whom they humanize by talking about his flaws (he was, among other things, a known and proud chauvinist) the same way one might talk about one’s simple dog. The audience is thus prepared for someone whose actions they might not always approve of, but whom they generally find likeable anyway.
When the authors introduce us to Lovaas’s early methods, which involved hitting children (he lamented in one interview that his department prevented him from hitting the children harder than he was), subjecting them to electric shocks from a cattle prod, and similar abuses, not only are we prepared to accept Lovaas’s faults as a person, but the authors take special care to ensure that we’re willing to accept this treatment of the children, as well. The authors take particular care to describe Lovaas’s early patients as “hopeless” and to indicate strongly that all of them relapsed without regular exposure to cattle prods and slaps to the face.
Lovaas’s use of “aversives” did face considerable pushback in the years after his approach was introduced. But at no point in the entire 65 pages that comprise Part IV do the authors themselves condemn these practices. Even as the authors are telling us about the pushback from other researchers and from certain parents, they remain carefully neutral about the use of aversives themselves. The use of certain other abusive methods, such as deliberately withholding food from children unless they did what they were told, is cast as beneficial therapy – not even a hint that it could be problematic.
The book stops just short of announcing that ABA remains some kind of “gold standard” of autism therapy that works when nothing else does. But it certainly sets up readers to draw that conclusion, particularly as it emphasizes the rhetoric of “recovery” that started following Lovaas’s work in the 1980s. In keeping with the previous chapters, it does not even attempt to ask critical questions, such as how the children felt while being subjected to the “therapy,” the long-term results on their well-being, or whether the “results” were actually the outcomes of ongoing development rather than the ABA itself.
(Full disclosure: One of my personal biggest concerns about ABA is that it is swamped in rhetoric about how it is “evidence-based” and “scientific,” when in fact there is no way to know whether the ABA is what changes autistic kids’ behavior, or if their gains are simply the result of their own developmental paths. Because we cannot create a control group for a condition that produces such highly variable developmental trajectories from person to person, we cannot test how any one person would have done with ABA versus without.)
The authors, incidentally, also have very little emotional reaction to Lovaas’s use of a cattle prod, or to the later development of the SIBIS system, which used electrical shocks as a response to self-injurious headbanging. They imply that electrical shocks are vanishingly rare in ABA programs, but they fail to mention that the Judge Rotenberg Center, among other places, still uses them – and that there is no evidence that they help anyone and a great deal of evidence that they harm.
Again, the authors utterly fail to connect the “past” to the present, implying that the “bad old days” are over when in fact they still lurk in the options presented to exactly the sort of unwary parent who would pick up this book.
This problem is so pervasive that it’s hard to get too worked up over this section’s other major flaw of note, which is that whenever the authors cannot find a clear “winner” to champion in a historical story, their otherwise brilliantly nuanced grasp of pathos deflates like a cheap balloon.
Halfway through Part IV, the authors talk about the work of Eric Schopler as a way to demonstrate the kind of pushback Lovaas was getting. But, since they cannot cast either Lovaas or Schopler as the clear “anti-parent” party, the story simply falls flat. It’s incredibly dry, and its dryness is incredibly obvious when compared to the heart-wrenching section on filicide or the vivid depictions of twentieth-century mental institutions. Without a parental audiences’ heartstrings to tug, the authors have little command of their material and even less understanding of it. Which is a shame, because the Schopler-Bettelheim and Schopler-Lovaas confrontations were entertaining in their own right.