Some twenty years ago when the National Alliance for Autism Research (NAAR) was established, the meetings were directed by Martha Denckla of the Kennedy Krieger Institute. Martha had graduated summa cum laude from Bryn Mawr College and cum laude from Harvard Medical School where she trained with the late great Norman Geschwind in behavioral neurology. Her numerous awards could only be rivaled by her self-assurance whenever she spoke in matters concerning autism. After a few meetings, it became apparent that any Applied Behavioral Analysis (ABA) grants would not be funded by NAAR as long as Martha was in charge of the meetings. She did not believe in the results of ABA but more so in its originator Ivar Lovaas. “He was an awful man. That thing he used on children was a mini-cattle prod,” she said.

Ever since those initial meetings I have had the chance to talk to some of Dr. Lovaas fellows and past colleagues. In many cases their opinion paralleled those of Martha. Although fond of using aversives, with time he seemed to have veered from using electric shock to slapping the thigh of inattentive or uncooperative autistic individuals. It really didn’t seem to matter why the patient was not responding, “You slap them,” was his constant admonition.

On one occasion Lovaas yanked the hair of an unresponsive patient in order to force him to look at him. After a grueling session that produced only suffering for the patient Lovaas asked one of his fellows to replace him in order to continue the “training”. As per instructions the fellow yanked the hair, and in doing so, discovered that the patient had a high fever. Other occasions were not all that different, patients who were unresponsive for various medical conditions (e.g. strong allergic reactions) were slapped or otherwise punished. “You treat the behavior, not its cause,” said Lovaas. Indeed, Lovaas used to receive frequent telephone calls from BF Skinner the father of Operant Conditioning. It is said that Skinner used to act as Lovaas’ cheerleader urging him on in his behavioral training of autistic individuals.

I have never understood how ABA obtained the positive results it did in its initial studies. One case report discussed in a round table by neuroscientists was that of a child who would not communicate intelligibly but otherwise would parrot sounds (echolalia) and was self-absorbed in his repetitive movements. Lovaas had urged slapping the child in order to make him talk correctly. A neuropsychologist upon listening to the recommendation said, “…but wouldn’t that be teaching him not to talk?”

The use of aversive treatment has been defended as a last resort measure in cases where maladaptive behaviors pose a threat to the safety of the individual and those around him. However, as in Lovaas case, the use of aversives is easily misused and its use generalized to all autistic individuals. Thankfully the era of aversive treatment is coming to an end.  ABA has now taken a twist for using positive/negative reinforcement and avoiding the use of aversives.

For other similar blogs see the story of John Nathaniel Rosen, in 3 parts starting at http://bit.ly/1cNOxOs