Children and Autism – Ennio Cipani
This is a book detailing the experiences of seven autistic children (chapters written either by the professionals involved or a parent) who underwent ABA (or another very similar Early Intervention Behaviour Therapy (EIBT)), and achieved “best outcome”. The term “best outcome” was first coined by Lovaas in his 1987 paper but it is used frequently in the current day as well, it basically means that the child is considered to have “recovered” from their autism.
All seven children achieved what is referred to as “best outcome status” as a result of the treatment. Best outcome status is a child who does not present the symptoms of autism anymore. That is, they are indistinguishable from their same-age peers. You could observe them at home, school, work, or in the community and not see any of the signs of symptoms of autism.
This is a contentious area of discussion within the field of autism and the autism community: there are autistic adults who have been deeply and negatively affected through therapy designed to get rid of their autism and to make them appear like their neurotypical peers, there are some who say that they have learnt skills that help them adapt to a largely neurotypical world but they are still autistic, there are others who agree that as adults they are no longer autistic, there are professionals who argue that autism is something that a person can “get rid of” through therapy, and others who say that autism is lifelong and does not “go” anywhere.
I take issue with the fact that “best outcome” is only considered to be achieved if a child appears to be neurotypical after therapy. Could the “best outcome” not be that a child grows up to live a happy and personally fulfilling life with a satisfying degree of control and independence? Why do they have to appear neurotypical for it to be the “best outcome”? Anyway, since we’ve been told in the introduction that these children obtained “best outcome”, we clearly know how each child’s excerpt is going to end before we start reading them.
The introduction spends a bit of time basically talking about how wonderful Ivar Lovaas was:
Dr. Ivar Lovaas, the founder of comprehensive early and intensive behavioral treatment (EIBT), developed the instructional procedures for teaching the basic building blocks of language and communication to children with autism. Many believe his greatest contribution to the field was his belief that children with autism could actually improve their language and social skills.
I’m not convinced that “greatest contribution” is the first phrase that comes to many people’s minds when they are considering the impact Lovaas had on the field of autism. Conveniently this book doesn’t mention the fact that Lovaas viewed autistic children as somehow less than human and needing shaping into humanity or the fact that he used aversives such as slapping and electric shocks, not even to say that ABA has moved on from Lovaas’s time.
That said, even with the introduction, I was interested to actually read what sort of therapy was carried out with the seven children. Just because I disagree with a form of therapy doesn’t mean there’s nothing I can learn from it. That’s when I came across another issue – one that I remember coming across in another ABA book – and that is that apart from for one activity at the end of the book, the methods or specific activities are barely described. There are the occasional vague references and minor details on methods but most of it is “the child needed to achieve this, and then they achieved it after x months” or a long paragraph of checking off things that the child learnt. To put it another way, there’s a lot of what they do but not much on how they do it, and it’s the how I’m interested in. I don’t know why this has been the case now in two ABA books I have read but there are two main reasons I can think of:
- They don’t want to give away too much information about ABA techniques.
- They think that if people read exactly how ABA was carried out it might put them off it.
In reference to that second point, there is in fact a chapter where the parents bring up their concerns about ABA based on reading they have done but within the space of two paragraphs they have been shown that all of these concerns are outdated and false, and that ABA is backed by scientific research and is generally wonderful.
There are also a lot of attitudes and opinions in this book that are just mildly unpleasant to read such as:
- “Self injury is how a child gets what he wants”
- “I was horrified several times by the appearance of the bus driver. Some drivers had biker tattoos…”
- “I had started to have serious reservations that the special class was helping her to develop at all, and, in fact, I was afraid that some of the things they wanted her to do (e.g use sign language) were making her less normal.”
- “Lisa came from an upper-middle-class home with two college-educated parents. How could the class be more enriched than what she already had?”
There’s sections throughout all the children which briefly discuss stopping stimming, taking away or losing objects that the child uses to stim with, discouraging children from talking about their special interests, and ways to get children to make eye contact (basically the child can’t have what they want without eye contact). Additionally, not only did all these children achieve “best outcome status”, but after the therapy almost all of them were top of their class and far superior to their peers in terms of academics and extra-curricular activities. I’m certainly not saying it’s impossible, all autistic people are different and will achieve different things, but it just seems so convenient that not only did these children “recover” from their autism but most of them are now also surpassing their peers in every way.
There is a final chapter where there’s two segments criticising “typical classroom methods”, followed by some more writing on how wonderful Lovaas is and then we finally get to read an in-depth description of an activity, entitled the “Get Me Game”, which is basically a game of fetch that can then be developed in a variety of ways which are discussed and outlined for the reader.
I would liked to have gotten some insight into how a full ABA program was carried out, to have read about the different activities and strategies that they used, but instead this book is mostly a padded out list of children’s achievements as a result of ABA therapy, with a whole bunch of statistics thrown in for good measure to show just how many months each child advanced in each area tested.
Is it worth reading?
If you like ABA then you will probably love this book since it’s basically seven accounts of how wonderful ABA was for these children. If you don’t like ABA then this book will do nothing to change your mind. If you want to learn about ABA then this book is basically useless because it doesn’t actually tell you anything of real depth about ABA. Depending on which category you fall into will determine whether it’s worth buying.
Lovaas I. O. (1987) Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology. 55(1):3–9.