© 2022 Published by KURA Education & Publish-
ing. This is an open access article under the CC
BY- NC- ND license. (https://creativecommons.
org/licenses/by/4.0/)

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International Electronic Journal of Elementary Education
January 2023, Volume 15, Issue 3, 199-208

Autism and Behavior Analysis: From
Dissonance to Dialogue
Karola Dillenburgera,*, Mickey Keenanb

Abstract

Introduction

Questions about human behavior and diversity have
captured the attention of scientists from a wide range of
philosophical stances for centuries. While behavior analysts
would argue that natural science is an enlightening
perspective when applied to the understanding of the
human condition, at times arguments within certain
campaigns would prefer Applied Behaviour Analysis (ABA)
to be banned or abolished. In this paper we discuss some of
the roots of this stance and suggest a way forward based
on what are basically complementary views on the goals
enshrined in rights-based practice.

Exclusion in all its many guises is an ugly thing and, in this paper, we discuss consequences that arise for autistic
individuals who have particularly high support needs
(American Psychiatric Association, 2013; Lord et al., 2022),
if applied behavior analysis (ABA)-based services were
abolished or excluded (Graber & Graber, 2023). We argue
that countering exclusion and ensuring real inclusion
requires dialogue and genuine empathy.

Autistic self-advocates commonly report the consequences
of discrimination, ableism, a normalizing agenda, being
viewed from a medical rather than a social model, and
misunderstandings concerning support needs (Tarvainen,
2019). Until the 1980s, autism was not officially recognised
(Volkmar et al., 1988) and profoundly autistic people (Lord
et al., 2022) were considered unreachable or unteachable
and commonly confined to a lifetime in institutional care
(Gómez-Durán et al., 2014). Those who presented with
challenging behavior were exposed to electroconvulsive
therapy (ECT) and/or physically and pharmacologically
restraint (Nielson et al., 2021; Schnitzer et al., 2020).

While this situation seems not to have changed in some
countries (Buivydaite et al., 2017; Lipinski et al., 2022), in the
1960s, behavior analysts in the USA were the first professionals
who were able to show that profoundly autistic individuals
were not “unteachable,” but that they could be taught and

Keywords:

Natural Science, Behavior Analysis, Human Diversity, Autism
Diversity, Discrimination

Received : 19 November 2022
Revised : 20 January 2023
Accepted : 8 March 2023
DOI : 10.26822/iejee.2023.292

a,* Corresponding Author: Karola Dillenburger, Queen’s
University Belfast, N. Ireland.
E-mail: k.dillenburger@qub.ac.uk
ORCID: https://orcid.org/0000-0002-3410-5949

b Mickey Keenan, Ulster University, N. Ireland.
E-mail: mickeykeenan@me.com
ORCID: https://orcid.org/0000-0002-5579-9169

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that they could learn (Ferster & DeMyer, 1962). They
applied the principles of behavior formulated by the
science of behavior analysis to design environments
that facilitated skills development for persons who
had been exposed to long-term care in designated
institutions. Since then, the field of applied behavior
analysis (ABA; Baer et al., 1968, 1987) has grown,
particularly with regards to supporting autistic
individuals (Surgeon General, 1999). So much so, that
today ABA is viewed as providing the basis for “gold
standard” interventions used to support individuals
on the autism spectrum (Koegel, 2011; Lovaas, 1987;
Smith & Eikeseth, 2011). With such a high profile, it is
not surprising that for some, the abbreviation ABA
practically became a synonym for a method of autism
intervention (Chiesa, 2006; Dillenburger & Keenan,
2009).

In the meantime, disability advocates achieved some
success in their fight against discrimination, health
disparities, and ableism (Borowsky et al., 2021; Nario-
Redmond et al., 2019; Tarvainen, 2019; Thorne & Barr,
2022), including extensive ratification of the United
Nations Convention for the Rights for Persons with
Disabilities (UNCRPD, 2006). As for autistic people, the
fight for awareness, acceptance, and equal rights
continues to be shaped by autistic self-advocates,
mainly through the newly formed neurodiversity
movement (Leadbitter et al., 2021a, 2021b; Silberman,
2015) as well as families of children with profound
autism (Unumb, 2013).

But somewhere along the way, something has gone
wrong. The special and supportive relationship
between behavior analysts and profoundly autistic
individuals and their caregivers that was built on
deeply rooted care and trust in science appears to
have been highjacked by an anti-ABA movement
that views the discipline of ABA as abusive, causing
post-traumatic stress, being ableist, and promoting
a normalizing agenda (Kupferstein, 2018; Milton,
2012; Sandoval-Norton & Shkedy, 2019; examples of
shockingly bad practice by poorly trained professionals
can be found on YouTube). The focus of this paper is
to discuss how those who have dedicated their lives
and their science to helping people (i.e., behaviour
analysts; cf., APBA, 2017) are being singled out and
accused as protagonists of all of society’s ills with
regards to maltreatment of individuals with autism.

While in his early writings Milton (2012) could be
viewed as one of the leading denigrators of ABA, more
recently he has sounded much more conciliatory and
even seemed to hint at the solution when he discussed
the double empathy problem (Milton, 2018):

…when people with very different experiences of the
world interact with one another, they will struggle
to empathise with each other. This is likely to be
exacerbated through differences in language use

and comprehension. (Theory of double empathy
section, para 1)

In order to balance a debate that generally is
dominated by the views of autistic self-advocates, we
offer an insider view of the perspective of behavior
analysts who aim to help profoundly autistic people.
What follows is an overview of our personal story
as behavior analysts and the struggles to address
the imbalance in discussions that could prevent
profoundly autistic individuals receiving the kinds of
supports that our science can offer.

Recently, we learned that the 3-year-old child we
met in 1997, and whose parents we introduced to
the discipline of ABA all those years ago, passed his
driving test and he got a job in the open employment
market. To be honest, that touched us deeply, more
in fact than when he was awarded his Master’s
degree in American History a few years earlier. Before
we met him, he had been assessed by all the usual
health and allied health professionals, none of whom
(according to reports by his parents) were able to help
him acquire even the most basic skills. According to
their clinical assessment reports, he was never going
to learn to speak in full sentences and was destined
for an institution. Together with his mother and other
parents, we established the charity “Parents Education
as Autism Therapists” (PEAT; the title was chosen
by parents). During the subsequent 20+ years, PEAT
helped hundreds of families build important life skills
for their children, we co-authored the first book about
ABA and autism in Europe (Keenan, Kerr, & Dillenburger,
2000) that has been translated into German and
Japanese (Keenan, Kerr, Dillenburger, et al., 2000), we
co-produced a multilingual multimedia online ABA
training platform that has been translated into ten
languages (German, Spanish, Dutch, Italian, Swedish,
Icelandic, Norwegian, Czech, Portuguese, Canadian
French, with Greek and Japanese in progress; Simple
Steps, 2013), and we collaborated in a range of large
scale research projects (Dillenburger et al., 2010, 2015;
Keenan et al., 2010; 2022)

These are remarkable achievements inspired by a
small parent-led charity that was established and
provided services for over 20 years without any support
from government. What is even more remarkable is
that this charity was set up in Northern Ireland, in a
context where their community has been torn apart
by violent conflict over many years (Dillenburger, 1991,
2007; Fargas-Malet & Dillenburger, 2016), and their story
continues to be one of struggle against prejudice,
discrimination, and repression, as oftentimes the
language used to caricature ABA (as ableist, abusive,
prejudicial, discriminatory, and pushing a normalizing
agenda), is itself ableist, abusive, prejudicial, and
discriminatory (e.g., Baron-Cohen, 2014; Kupferstein,
2018; Sandoval-Norton & Shkedy, 2019).

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Here is the problem. As behavior analysts, we think
differently from most other people. As scientists, we
avoid mentalistic pseudo-explanations for behaviour
(APBA, 2016; Chiesa, 1994; Green, 2016; Skinner, 1953b;
Thyer, 2009; Thyer & Myers, 1999; Thyer & Pignotti,
2010). Instead, our raison d’etre is the discovery of
fundamental principles of behavior. We investigate
the intimate relationship between environmental
contingencies and behavior. The language we use to
describe these relationships is full of what sounds like
“jargon” to those who are not familiar with the science.
A point to make here is that in any other science the
terms scientists use may appear strange, cold, alien,
even overly technical (Keenan & Dillenburger, 2000).
This is because the terms scientists use are short-hand
for discussions with other scientists, and therefore
they have to be defined very carefully. As Milton (2018)
realised, there are “differences in language use and
comprehension” (Theory of double empathy section,
para 1) that can hinder communication between
people with different experiences, as would be the
case between scientists and non-scientists.

In fact, while the everyday language we inherit from
our parents has its role in everyday life, it interferes
with the precision required by science (Skinner, 1953b)
and thus does a poor job for scientists (Chiesa, 1994;
Moore, 2013a). Take for example, the term “behavior.”
In everyday use of the term, it refers to "the way in
which one acts, especially towards others,” oftentimes
meaning “bad behavior” (e.g., "Did the children
behave?;" Cambridge University Press, 2020). In
contrast, when behavior analysts talk about “behavior,”
we define the term behavior as the “interaction of the
organism with their environment,” both, historically as
well as currently (Cooper et al., 2007; Phelps, 2007).
We talk about lifelong “learning histories” as well as
“cultural meta-contingencies” that impact on present
behavior (Glenn, 1988, 2004). This holistic view of
behavior includes private behavior (what happens
inside the skin, e.g., thinking and feeling; Skinner, 1977;
Keenan & Dillenburger, 2022 Mentalism Chapter) as
well as public behavior (e.g., moving and speaking;
Skinner, 1953a, 1957). The image of a stream or river
is helpful here. We cannot talk about a river without
referencing both the water and the banks through
which it flows. Likewise, behavior analysts consider
that the skin does not separate us from the world,
but it connects us to it. This is a completely different
way of viewing the world in which we live, with major
implications for understanding the process of living
where a typical lifespan can be over 2,208,988,800
s. Called the behavioral stream, the process of living
is viewed as a stream of experiences accumulated
throughout one’s lifetime (Keenan & Dillenburger, 2022,
Behavioural Stream and Private Events chapter).

There is no formal “diagnosis” for our way of being,
nor should there be. As behaviour analysts we are just

different, with diverse views within our community.
The science we employ to study behavior is attracting
more people from around the world (see ABAI, 2022;
APBA, 2016). Yet, we are being told by some (e.g., the
neurodiversity movement) that we are wrong in what
we are doing, even alleging that we are causing
harm and abusing vulnerable children on the autism
spectrum (Sandoval-Norton & Shkedy, 2019). They
demand that everyone (and that includes behavior
analysts) conform to their normalizing agenda and
their way of doing things (Milton, 2012).

As mentioned previously, when behavior analysts
study the behavioral stream, the goal is to increase
awareness of how behavior is affected by
environmental contingencies. This is a formidable
task and the methods that have been developed
have enriched lives in a wide range of areas (see
Cambridge Centre for Behavior Studies, 2022; Heward
et al., 2022). Sharing the findings from behavior
analytic research is not without its problems. When
autistic children experience severe challenges,
commonly parents seek guidance on how to design
experiences for their children in order to facilitate
the emergence of confidence and independence. In
other words, parents need to learn how to implement
“interventions” with precision and fidelity. Behavior
analysts have developed many strategies for designing
bespoke experiences that straddle education and
health issues. Denying either the existence of the
principles of behavior or their relevance to education
and health is simply not an honest way to proceed.

In contrast to North America, where there are laws
to ensure ABA-based interventions are available to
those who need them (Unumb, 2013), in Europe the
misinformation about ABA disseminated by people
not trained in the science has resulted in ABA-based
services generally not being endorsed by governments
(Keenan et al., 2022). In fact, some parents report that
they have been threatened with the removal of all
autism services if they continued with their ABA-based
home programs (Dillenburger et al., 2015). Intriguingly,
these threats occur even though their children are
making progress at home and are learning skills
that they did not learn at school (Larsson, 2021).
Keenan (2016) pointed out that this kind of anti-ABA
perspective implies that parents who seek to improve
their awareness of how best to educate their children
should apologise to their children. Maybe they should
say things like “We didn't know that by educating you,
by preparing you for the future, we inadvertently did
not ‘accept you as you are'?" (Keenan, 2016, p. 10). Or
maybe they are supposed to say to their children:

Please forgive us for designing experiences for you to
have fun, for toilet-training you, for helping you make
friends, for supporting you to manage your self-injury,
for teaching you to communicate, for giving you the

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skills to make choices and convey your individuality,
and for expressing our love for you in numerous other
practical ways. We did not know that this could be
interpreted negatively, as trying to change who you
are or as trying to make you ‘normal’ (Keenan, 2016,
p .10).

Those who perpetuate myths about behavior analysis
are missing the point completely if they consider these
parental apologies to be necessary. On one hand they
dismiss the whole science because they object to the
idea of “deliberately doing something to change a
person” (i.e., education). Yet in the next breath, they
propose to engage socially with a person in applied
settings in the hope that the person be supported
or empowered (i.e., changed). The additional layer
of awareness provided by the science of behavior
analysis in relation to the effects of environmental
changes is considered an anathema. What is truly
very sad about this situation is that it impacts directly
on the benefits to be derived from awareness of
how environmental contingencies contribute to the
outcomes of education.

The anti-ABA stance generally is at odds with the
science of behaviour analysis for a number of other
reasons. Behavior analysis embraces the full spectrum
of neurodiversity and there is no better evidence than
the way it addresses the differing educational needs
of each person in applied settings (Kazdin, 2010).
To ensure that the focus is on the individual, we use
single-system research designs to monitor changes in
the behavioral stream (Keenan & Dillenburger, 2011)
instead of using comparative group designs which
commonly leave one group without support that may
be desirable (e.g., NICE, 2013).

The result of the spread of misinformation is that a
whole science has been branded as controversial
(Parker, 2015) when the real controversy should revolve
around the deliberate dissemination of misinformation.
The misrepresentation is so pervasive in Europe that
on one hand it is said that it would be wrong to invest
in only one “thing” like ABA, while on the other hand it
is argued that it is acceptable to invest in one “thing”
called an “eclectic approach,” even though there
is evidence that ABA-based interventions are more
effective than eclectic interventions (Howard et al.,
2005, 2014). Unfortunately, no-one addresses the
ethical questions that arise from the role played by the
Dunning-Kruger effect (Benzel, 2022; Hofer et al., 2022)
when misinformation and the associated caricatures
of ABA form the basis of government strategies and
policies (Dillenburger et al., 2014). Vyse (2022) is right
when he says:

It is one thing to form a social movement in an effort
to gain greater acceptance of and better supports
for a group of people in need. It is quite another to
do so at the expense of another group who is also in

great need. Helping people on the autism spectrum
should not be a zero-sum game with gains at one
end of the spectrum requiring losses at another.
Unfortunately, the autism self-advocacy movement’s
attacks on ABA [applied behavior analysis] create just
such a dilemma (The Death of Truth and Freedom
section, para 3).

To ward off the onslaught of the anti-ABA perspective
(Note: this language is often used by parents on
the receiving end of misinformation), some have
suggested that it might be best to change the name
of ABA. This suggestion is truly symptomatic of the
stresses to which parents are exposed. What other
science has to contend with a name change as a
strategy for managing the aversive consequences
produced by discrimination and prejudice. One of the
authors (MK) explains:

As a child who grew up in N. Ireland, I am familiar
with many facets of prejudice. Raised by a Protestant
mother and having a Catholic father, I experienced
at first hand the damaging effects of misguided
conclusions conceived in the shadow of myths.
When visiting my grandparents, it was at times a
surreal experience to cross from one perspective
tainted by prejudice to the other perspective similarly
tainted by a different kind of prejudice. I was exposed
to exclusion and discrimination based on prejudice. In
many walks of life during my childhood, Irish people
were not welcome, as expressed in the sign in the
window “No Irish”.

Never did I imagine, though, that in my professional life
those scenes from my childhood would be replayed.
I should have known better. Behavior analysts are
not welcome. The sign in the window should read
“No ABA’ or “No Behavior Analysts.” In Shakespeare’s
play Romeo and Juliet, Juliet described the conflict
between the rivalling families with the poetic words:
“A rose by any other name would smell as sweet.” The
families of my own parents, and the families described
by Shakespeare, were not able to break free from
the experiences that shaped their beliefs in order to
accommodate another with different experiences
and consequently a different perspective.

Yet, many parents of children with autism have
been able to break free from the misinformation
and myths about ABA and as a consequence their
children have benefitted greatly (e.g., ABA4All, 2022).
Unfortunately, we have seen parents pushed to the
point of exhaustion in defence of ABA in courts and
tribunals fighting for their children’s rights to have
access to ABA-based interventions (Blakemore,
2021; Byrne & Byrne, 2000). Where else would this
be allowed to happen? Where are the investigative
journalists who want a human interest story, one
about how health and education authorities peddle
misinformation about a science in which they are not
trained, while parents do what they can to defend
a science which they evidently understand better
than those professionals (Dillenburger et al., 2012)? The
ethical drama that is played out in these situations
simply is staggering and at the same time diabolical.

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It is almost as if the parents are put on trial for being
witches, inhuman creatures who are hell bent on
harming their children. The truth is that these parents
are heroes, mustering all of their love to defend the
opportunity for their children to acquire skills that
others believed they were unable to acquire. So much
for equality of opportunity and disability rights. So
much for the rights of their children to be regarded
as people deserving of the opportunity to be guided
by a science dedicated to bringing out the best in
people through its accumulated understanding of the
principles of behavior change.

Clearly, those who are against ABA are not the
only bastions of love for children. Nevertheless, ABA
professionals who guide parents when educating their
children continue to be maligned for doing so. It is worth
stating that again in other words. Parents who have
used the discipline of ABA to successfully empower
their children and improve the quality of their children’s
lives have been criticised for doing so. They have
been criticised because some people proposed that
the evil world of ABA could never produce something
positive. Indeed, they would consider these parents to
have been duped into adopting a perspective that
emphasises the importance of normalizing children,
and not accepting their uniqueness. One of the
authors (MK) elaborates:

When I hear that kind of misguided anti-ABA rhetoric,
I find myself straddling the mindsets of both sets of my
grandparents (one set from a Protestant background
and one from a Catholic background). It was never
possible for them to accept that something positive
could emanate from the other camp. Of course, this
was not always the case for them, but when it came
to important matters that divided the community,
they each held firm to how they had been taught
to view their nemesis. My time growing up in a
divided community has brought many stresses to me
personally. But it has also educated me in showing
how twisted logic is used to defend either position
when it is challenged. There was a time in my
childhood, for example, when one could have been
challenged in the streets along these lines:

“Are you a Catholic or a Protestant?”

“I am an atheist”

“Are you a Catholic atheist or a Protestant atheist”

There is no normalizing agenda at the heart of ABA.
Apart from this correction, there is another misguided
criticism that needs to be rebuffed. It is said that using
ABA is tantamount to using a one-size-fits-all approach
that ignores individual needs. This one-size-fits-all
criticism is entirely misleading because there is indeed
one thing that is used by the scientist/practitioner to
guide the development of bespoke services, and it is
called the scientific method. But this is entirely different
from the kind of plug-and-play conceptualisation of
one-size-fits-all conjured up by authorities who refuse

to invest in ABA. Surely it cannot be wrong to employ
professionals who use the scientific method in the
21st century for designing bespoke services. Nurturing
an individual using the scientific method so they
can feel empowered by the acquisition of skills is an
enlightened act of human kindness, not the act of a
despot intent on removing their uniqueness (Keenan &
Dillenburger, 2020).

To conclude, here is an example that illustrates what
can be achieved with good quality ABA-based
interventions. Following it is a contrived example
of the sorts of criticism that have been levelled by
others in the face of something that does not sit well
with preconceived ideas about the nature of ABA.
This case study was provided by Dr. Nichola Booth
(personal communication):

A young boy, 8 years old, had a confirmed diagnosis
of autism and was non-verbal. It was reported
that he had excessive amounts of saliva that was
impacting on his day-to-day social and educational
experiences. At school he was being isolated from
his peer group as he was rubbing the saliva over
other children, teachers, classroom assistants and
equipment. The same behaviors were happening at
home to the point where his parents would not have
visitors because their furniture was covered in dried
saliva. His clothing was destroyed from being caked
in dried saliva.

After medication failed, the parents went back to
their GP. It was at this stage that they were told the
next step would be a referral to a surgeon for an
invasive operation where a piece of his mouth would
be snipped to reduce or eliminate the extreme levels
of saliva. Due to waiting times for this appointment,
the parents accepted this and went home.

While waiting for the hospital appointment the
parents decided to access the services of a behavior
analyst for support, but nothing related to the saliva
issue. The ABA professional came to the family home
and carried out parental interviews and behavioral
observations to determine what supports would
be required. While carrying out the observation he
noticed the behavior associated with excessive
saliva production, especially the wiping of the saliva
on all items and people within the room. This was
raised as a potential issue to be addressed and it was
then that the parents explained what had happened
to date. The behavior analyst suggested that they
could perhaps put a programme in place to see if
this behavior could be reduced without the need for
surgery. The parents agreed.

Following collection of data from additional
observations, both at home and at school, a plan
was developed. A sensory tray of all ‘goo-like’ items
was made and placed in the main family room in the
home. Alongside this, a visual sign for the tray was
made available across the home environment for the
child to access.

The parents were educated in how to identify when
the excessive saliva related behaviors were about
to occur – these included heightened vocalisations,

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hand-stimming, and facial movements. When the
parents saw these behaviors, they were immediately
to prompt the child to point to the visual for the
sensory table visual and then immediately redirect
him to the sensory tray. He was then requested to
‘play’ and the parents modelled some of the playing
behaviors for him with the items in the tray.

This strategy was implemented successfully in the
home with the saliva related behavior reducing
significantly before it was introduced in the school
setting. The end results was that surgery was no
longer required and the behavior had decreased
with the child being fully reintegrated back into
school and other social events.

A Critique of this Case Study

It is awful that the child was not accepted for who
he was by both the medical professional and the
ABA professional! Instead, they each attempted to
normalize him, one using drugs and then proposing
an invasive surgical procedure. The ABA professional
was more deceptive and hood-winked the child
into changing his behavior, thereby refusing to
acknowledge the child’s need to engage in his
preferred activity!

Conclusion

With so many parents of profoundly autistic children
now championing ABA while others try to stop all ABA,
it is clear that something is amiss. As can happen in any
profession, some people have been on the receiving
end of malpractice. In medical practice, some people
have even been murdered by their doctors (Gunn,
2010) and of course, the actions of such people must
be restricted, but not at the expense of the entire
discipline of medicine. The same has not been the
case with ABA. It seems that some malpractice has
led to the condemnation of the whole science.

In the midst of the struggle for equality, one very
important point should not be overlooked. There
is a strategy often fostered by an establishment in
many walks of life called “divide et impera” [divide
and conquer], an approach that Julius Cesar used
successfully 22 centuries ago (Razzetti, 2018). While
autistic self-advocates and behavior analysts are at
logger heads, the establishment does not need to
change and can continue to discriminate unhindered.
This paper is a call from behavior analysts to autistic
self-advocates to heed Milton’s (2018) call for the full
appreciation the double empathy problem and join
together against the real nemesis of autistic people,
societal and political discrimination, inertia, and
indolence.

Competing Interests

Authors are Irish doctoral-level behavior analysts and
identify as somewhere on the spectrum of human

diversity. They have no financial or non-financial
interests that are directly or indirectly related to the
work submitted for publication. No funding was
received for research reported here.

Author Contributions

Authors contributed equally to the paper.

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