This Letter to the ASHA Leader Editor is being circulated for signatures from speech-language pathologists who share the expressed concerns regarding the article “Building Working Relationships With Applied Behavior Analysts” that appeared in the April 2020 issue of the ASHA Leader. The letter is sponsored by the SLP Neurodiversity Collective (SLPNDC) and authored by Therapy Chair for University Involvement, Dr. Amy Lustig, Ph.D., CCC-SLP.

To the Editor:

The above-named article, which proposes that cross-disciplinary collaboration best serves the interests of clients of speech-language pathology (SLP) and applied behavior analysis (ABA) services, is built on several faulty premises. First, it assumes a reciprocal inability across professions to stay within each of our respective practice parameters. From a purely practical perspective, this is absurd, given that ABA services are reimbursed at up to 40 hours per week, and SLPs are fortunate to receive compensation for 1 or 2 weekly visits. Second, it suggests the breakdown in cooperation across professions is associated with poor SLP awareness of ABA practices, and that SLPs bear the burden of improving our knowledge of behavioral terminology and intervention. However, it has become excruciatingly clear to anyone who is professionally engaged with these clinical populations that the ABA profession openly and enthusiastically encourages its members to target therapy goals, such as expressive / receptive language and motor speech production, that are clearly out of their professional scope of practice.1 As a group, ABA providers have demonstrated their inability to establish appropriate boundaries and to recognize the limits of their professional competencies. The burden of responsibility for creating and enforcing these necessary professional boundaries falls on the SLP, eclipsing the value of, say, clarifying what the term “autoclitics” means.

Perhaps the most troubling aspect of this picture concerns the implicit approval by ASHA of the core ABA practices which, driven by an overall poorly-designed and biased research literature, are steeped in clinician-driven agendas, reward/punishment reinforcement systems, and imposed behaviors such as forced eye contact and demanded food intake that elicit client discomfort and resistance, which are then ignored as part of the behaviorist protocol to “extinguish” the “unwanted” resistive behaviors. There is a sizable and growing cohort of evidence, from anecdotal to peer-reviewed reports, that recognizes participation in ABA therapy can cause outcomes ranging from distressing to traumatizing.2,3 With the caveat that not all ABA providers are associated with such poor results, the fact remains that enough evidence for these exist such that ASHA, as a professional organization ostensibly concerned with client welfare, bears a responsibility to the public good to acknowledge that participation in ABA therapy carries a reasonable risk of adverse outcomes, and to encourage careful consideration before making that decision. To date, ASHA has made it clear that it has absolutely no interest in taking such a public stand.

ASHA has recently stepped up to provide support to state associations where ABA providers have attempted to encroach at the level of the professional license, and this has been appreciated. However, the organization’s failure to establish a clear perspective on the current state of ABA treatment, to vigorously advocate for appropriate professional limits where scope of practice is concerned, and to acknowledge the very real potential for negative outcomes associated with the therapy, are egregious oversights.

1California ABA provider advertising language treatment services, now a frequent and inappropriate goal of ABA providers. https://www.centerforautism.com/services/therapy-programs/child-services/

2Reichow, B., Hume, K., Barton, E.E., & Boyd, B.A. (2018). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). The Cochrane Database of Systematic Reviews, May 2018(5). doi: 10.1002/14651858.CD009260.pub3

3The Department of Defense Comprehensive Autism Care Demonstration: Quarterly Report to Congress (2019). United States Department of Defense, Second Quarter, Fiscal Year 2019.
https://health.mil/Reference-Center/Congressional-Testimonies/2019/06/10/Annual-Report-on-Autism-Care-Demonstration-Program