According to a recent announcement made by ASHA, Speech-Language Pathologists (SLPs) will soon be able to become Board Certified Specialists in Autism Spectrum Disorders (BCS-ASD) if they “have completed training related to the implementation and supervision of evidence-based intervention programs in a variety of areas including social communication skills, speech, language, and behavioral programs.” The reason for this new credential is “Consumers often seek the services of a professional with “expert” status, and employers are looking for staff who demonstrate that they have specialized clinical expertise at an advanced level…you will join a network of outstanding professionals who share your interests and experience.”
Although specific information about this certification, or the process of creating it, has been alarmingly scarce, this secondary source mentions a few more details.
- According to an unnamed board member, the certification process will involve “many components of applied behavior analysis SLPs should have.”
- Lynn Koegel, the person who initiated this process and is listed as the primary contact for questions, is one of the founders of Pivotal Response Training (PRT – similar to ABA but applied even more systematically). She also founded the Koegel Autism Center.
- In a presentation at the ASHA convention last year, it was revealed that BCS-ASD speech therapists may be able to oversee PRT.
The second point is easy to verify with a Google Search. So my first question is: are the first and third points true? If not, please feel free to disregard the concerns I have about them. Not to worry, I have several other points to raise here.
I have been a Speech Language-Pathologist (SLP) for six years. During that time, I’ve worked with autistic people of all ages in almost every setting. I’ve done everything from AAC to articulation to conversational skills. I’ve given inservices, advised family members, and recommended environmental modifications. I’ve been bitten, punched, and pulled out of my seat by my hair. I’ve had long and fascinating conversations about religion, ecology, and our solar system. (That last one, by the way, was with a four-year-old.) I’ve had my worldview challenged multiple times and in many ways, and I am a better person and therapist for it.
I have learned a ton about life, the universe, and myself from autistic people. I don’t say that to be cliche; it is literally true. Not too long ago, I myself was diagnosed with autism.
I’m telling you all this because I need you to understand how familiar I am with the scope and variety of strengths and needs in the autistic population. I have a number of concerns with your BCS-ASD program, and these concerns are coming from a place of knowledge and expertise, both personal and professional.
1. The description of this certification does not mention Augmentative and Alternative Communication (AAC) or Auditory Processing.
Your description refers to three different aspects of communication (social, speech, and language) but omits two that are particularly significant to the autistic population. First, you make no reference to AAC even in general terms, even though a substantial portion of the autistic population uses AAC to communicate. Second, you fail to include auditory processing, which is another aspect of communication that presents a significant difficulty to many autistic people.
Your description of the BCS-ASD ignores two aspects of communication that are essential to significant portions of the autistic population. It is irresponsible to say that a therapist who specializes in communication has specific expertise with Autism Spectrum Disorder without first requiring the therapist to demonstrate knowledge and experience of issues that are vital to understanding the strengths and needs of autistic people.
2. The description mentions one skill that is tangential to the SLP scope of practice, but excludes others.
Nowhere in your description is there any mention of sensory processing. This would make sense, given that sensory processing falls outside the SLP scope of practice, except that you do mention a different field outside of our practice: behavior. Sensory needs and outward behaviors are both essential to understanding the strengths and needs of autistic people. So, it is perplexing that you have included one but not the other.
3. There is no reference to the involvement of autistic people in developing this certification.
Aside from the ambiguous meaning of the word “consumers,” you make no effort to describe how this certification benefits autistic people directly, or what (if any) role autistic people have played in developing the BCS-ASD program. There is no information on how many (if any) autistic people were included on the board. If you do not allow autistic people to participate or even consult, you cannot be sure you are meeting the needs of the autistic community. You are making decisions that affect autistic people without allowing them – us – to have a voice.
4. ABA was specifically mentioned as a requirement for receiving the BCS-ASD.
This is a big one, so bear with me.
Even the U.S. Education Department acknowledges that ABA is not the only treatment method for autistic people. It is extremely well-known, but it is not a requirement, especially for communication therapy. Six years of clinical experience has taught me that I do not have to use ABA in order for my autistic students or clients to make progress in their communication. Yet ABA is specifically mentioned as a requirement for SLPs who want to specialize in Autism.
ABA has a deeply problematic history. Ole Ivar Lovaas, the man who founded it, has gone on record saying horrifically dehumanizing things, including:
“You have a person in the physical sense — they have hair, a nose and a mouth — but (autistic people) are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build the person.”
“believe me they are monsters, little monsters”
“I just reached over and cracked her one right on the rear. She was a big fat girl so I had an easy target. …And she stopped hitting herself for about 30 seconds…and then she hit herself once more…I felt guilty, but I felt great. Then she hit herself again and I really laid it on her. You see, by then I knew that she could inhibit it, and that she would inhibit it if she knew I would hit her. So I let her know that there was no question in my mind that I was going to kill her if she hit herself once more, and that was pretty much it. She hit herself a few times after that, but we had the problem licked.”Interview in Psychology Today, 1974
With these quotes in mind, it is not surprising that preliminary evidence shows a significant portion of people who experience ABA show symptoms of post-traumatic stress later in life.
But wait! You might say. ABA has changed! It’s better now! To that I respond: not exactly.
Here is a parent listing problems with “the new ABA.” Here is another one. Here is an autistic person analyzing videos of “modern ABA” practices. If you only have time to look at one of these three sources, I particularly recommend this last one.
You may not have time or energy to read any, so here are some of the common points:
- ABA is, at its core, compliance training. It teaches children to do what they are told, when they are told, because they are told.
- Compliance training teaches children that they are not allowed to say no to something that is unpleasant or uncomfortable to them. ABA with physical prompting teaches children that other people can touch and manipulate their body without their consent. This can leave them vulnerable to serious abuse in the long term.
- ABA does not always consider the ways that behavior is communication. When it does, it often uses this knowledge to force or manipulate a child into doing what practitioners want them to do.
- ABA practitioners ignore the way that children are feeling in the moment. This teaches children that their feelings are wrong or unimportant. The assumption that children need to “earn” things they need or want teaches the same thing.
- Even “new” ABA uses aversives in the form of “planned ignoring,” meaning that if a therapist doesn’t like a child’s behavior, they simply ignore the child until it goes away. This practice teaches children that their voice is only worth using if they’re expressing something that adults around them want to hear
- ABA takes away from the time that autistic children get to spend being children, enjoying themselves, and exploring the world on their terms.
Yes, there are individual ABA practitioners out there who choose to implement ABA in a way that does not do these things. Yes, there are ABA practices that can benefit children of all neurotypes in a way that is not harmful. For example, if a child communicates “silly putty” to me, and I immediately give them silly putty, I am using principles of ABA to reinforce successful communication. I understand this.
However, when a therapist or educator implements ABA without also valuing the child’s unique way of perceiving and interacting with the world, in the long-term they do more harm than good. I know, because I’ve seen it happen.
I have worked with many, many children and adults who have been taught through ABA or related practices that their feelings don’t matter, that the things they need or enjoy always need to be “earned” by doing what adults ask. Do you, the members of this board, understand how difficult it is to improve the communication of someone who has been trained not to trust themselves? I end up using a trauma-sensitive approach with students who have no source of trauma in their lives other than years of ABA. Do you realize how heartbreaking this is? Can you empathize, even for a moment, with the people you are trying to help?
Regardless of whether you are able to use perspective-taking skills on autistic people, there is empirical evidence that not all ABA targets or practices are effective. For example:
- Using exclusively extrinsic motivation stops being effective as soon as the external rewards are removed, because intrinsic motivation has not been developed.
- Simplifying tasks is not necessary to promote learning in autistic students.
- Isolated and repetitive trials make it difficult for autistic children to apply learned information in other contexts.
- Neuroimaging studies show that eye-contact is neurologically painful and upsetting for autistic people.
- Stimming, or “restricted and repetitive behaviors” doesn’t impede autistic children’s ability to engage with toys in a meaningful way.
- Using autistic students’ special interests in a way that is intrinsic to a lesson is more naturally engaging, which results in more effective and enjoyable learning.
- Masking, i.e. pretending to be a non-autistic person, is linked with suicide in autistic adults. This is especially problematic because the social communication portions of ABA deliberately and systematically teach autistic people to mask.
5. There appears to be a Conflict of Interest with the person in charge of the BCS-ASD program.
Although behavior is mentioned as an important component of working with autistic people, AAC, auditory processing, and sensory processing are all omitted. This pattern of omission, given that Lynn Koegel founded a form of behavior therapy, is concerning on its own. If the first and third bullets from above are true (the certification will require knowledge and/or experience with ABA; people with the BCS-ASD will potentially be supervising PRT practitioners), the Conflict of Interest becomes even more problematic. At best, the specific experiences of the person who initiated this program are causing an inadvertent exclusion of areas that are vital for understanding communication in autistic people. At worst, the founder of PRT is creating a specialty certification, under the guise of improving services for autistic people, that will channel more money into programs that she developed. Either way, there are deeply concerning ethical issues about this process which need to be addressed immediately.
The bottom line is this: in your BCS-ASD program, you adhere to a specific perspective of autism that sees ASD as a behavioral disorder to be treated using reward-and-punishment compliance training. In doing this, you fail to include multiple traits of autistic people that are directly relevant to SLPs, even though you do mention behavior, which is not. You give no consideration to SLPs who have a different perspective of autism. According to this description, any SLP who has ethical problems with ABA will not qualify for this certification, no matter how much experience they have had with the autistic community. You anticipate that certified therapists will be able to supervise PRT providers, without acknowledging the Conflict of Interest this presents, given that the person who initiated the process is the very person who founded PRT in the first place. Worst of all, you fail to mention whether autistic people had any role in establishing this certification program.
When I first heard that a program was being developed for SLPs to obtain a specialty certification in autism, I laughed. I really did. My initial thought was that I already have certification in SLP and ASD, so I guess I’m all set! Obviously that’s not what you have in mind. Indeed, a large portion of the SLP professional culture doesn’t believe it’s possible for autistic therapists to exist.
But this isn’t about me.
This is about the autistic people I work with being, once again, defined in a very specific way that ignores significant needs and accommodations while pushing treatments that have the potential for harm. At best, this program is ableist and exclusionary. At worst, it’s ableist, exclusionary, and corrupt.
It’s not just that your perspective is different from mine. It’s that the possibility for variations in perspective are ignored, that preference is shown for the perspective that stands to financially benefit the people coordinating this process, despite the potentially harmful impacts on the people we are claiming to serve.
I am an autistic speech therapist, and I love working with my autistic students. I love helping them communicate, and I love helping the people around them appreciate them for who they are. This is something I have devoted a significant amount of my time and energy to for several years, and I hope to continue in this capacity for many years more. Autism helps me in this regard because it gives me the intense passion and hyper-focus that allows me to put everything I have into helping people in the autistic community find their voice and use it as effectively as they can. I would hope that at least one person on the board can understand this.
I am asking you to reconsider the criteria for this certification. I am asking you to either mention sensory differences AND behavior, or mention neither at all. I’m asking you to include AAC and auditory processing under necessary areas of expertise. I’m asking for acknowledgement that autism is – in addition to being a neurological disability – a difference in perception and communication that is exacerbated by stigma and lack of understanding from non-autistic people. I’m asking you not to require SLPs who work with autistic people to endorse ABA.
Most importantly, I’m asking you to consider the wants, needs, and preferences of autistic people when you create programs that affect them as directly as this one does. I’m not asking to be personally included; I am, after all, an anonymous blogger and I intend to stay that way. I am asking for someone – even one person (though preferably more) – on the autism spectrum to give input into this program, and for their perspective to be valued and considered very carefully. You claim you want to help autistic people. So do that.