Normalization?

So much to say on this topic, far more than anyone would actually want to read.

Does ABA therapy require/demand/force individuals into a narrow and specific box titled "NORMAL"?
No. 
(Well, it shouldn't anyway)



I mean this in the best way, but many of the children I work with just are not going to fit into that "normal" box, no matter how much someone tries to push or squeeze them into it... it ain't happening.

And that's a cause for celebration!

The very thing I love about working with such a diverse group of kids, is that they are all different, yet all interesting. I work with some super fascinating small people, who constantly show me how dumb I am. And I thank them for it, because how can you grow if you already think you know everything? You can't.

As a provider, of course I know the research on the effectiveness of ABA therapy. I also know the many success stories I have seen with my own eyes, of children I directly worked with. But success story does not equal "...and then the child was totally normal!".

A couple of reasons why my job is not to drive families in my car to a fantasy location called "normal":

1) Each client/family I work with usually has their own idea of what "normal" means. If you have been in this field more than 10 minutes, you know this to be true. This client over here may live in a home where no one really cares what time they go to bed, as long as they stay in their room and are quiet. But that client over there, may live in a home where all the parents want most in the world is for that child to get their 7.5 hours of sleep every night.
2) Even when a family can explain to me what "normal" means for them, it quickly changes! Again, if you have been in this field more than 10 minutes you know this is true. Sometimes parents tell me they want desperately for their child to talk, but what they really mean is they want their child to communicate. Or, a parent may tell me they want desperately for their child to go to "normal" school with their big sister, but next thing you know that parent has decided to homeschool. Expectations change, as perspective changes.


So if ABA therapy is not about hitting a child over the head with your magical "normal" baseball bat, then how exactly is it decided what the goals of treatment will be? I'm so glad you asked.

If you are working with a quality ABA provider, the goal selection process will look something like this:

"I need to evaluate/assess your child to collect baseline data" – This just means data is collected at the onset of services to create a starting point. Over time, that starting point data will be reviewed again and again to make sure the child is progressing. If therapy has been happening week after week after week, but the child has not progressed past that starting point, then something is seriously wrong. This is why it’s important to collect that initial data, so over time you can compare the child’s current learning to their previous learning.

"What are your goals for therapy? Tell me the reasons why you initiated services." – The people who asked the ABA team to show up clearly had reasons for doing so, and we need to know what those reasons are. We cannot fully help if we don’t know what issues are happening. Treatment planning should always be a team effort, with the family/client working together with the BCBA to create goals.

"Let's discuss what your child's needs and wants are" - For many practitioners, the individuals we support cannot request our services, and they cannot communicate what THEY want out of therapy. But, it is still very much our job to not just design an intervention for them, but with them. You may be wondering how the heck would be possible for a non-verbal client? Preference assessments, skill probes, treating escape as a removal of assent, and embedding client interests and special hobbies into the treatment plan, would all be my suggestions. 

"What are the highest priority areas of concern in the home? At school? In the community?" – What this question is really getting at is “where do you want to start?”. It isn’t unusual that families want to work on…oh, 85 behaviors or so when you first meet them. Unless I can get a good idea of the priority level of those 85 things, the treatment plan will be a chaotic mess. Prioritizing treatment helps focus in on the areas of deficit that are impacting the client the most.

"Describe your household: rules, routine, disciplinary procedures commonly used, etc." – This question gets at Culture. Households form a sort of culture, or a way things are done. Stepping into a household/family dynamic and imposing completely opposing culture onto it, is not a great idea. It will likely lead to aggressive resistance. What is more helpful, is to teach the family strategies and techniques that line up with the way their household functions.

"Can you finish this sentence: In 5 years, I want my child to be able to....." – This question is really getting at long-term goals. Professionals need to know long-term goals, because every long-term goal is really made up of hundreds of baby steps. Gradually introducing those baby steps leaves less work to do down the road and increases the likelihood of successful skill acquisition.

"Your child scored low on (insert skill domain here). Do you care about that??" – One of my fave questions to ask. I have learned to ask this, because I used to do quite a bit of assuming. Things like “Of course, you guys want him to write his name, right?” or “Of course, you guys want her to stop eating with her hands, right?”. Maybe not. If I see an area of concern, I will bring it up. If the parent isn’t as concerned as I am or wants to stick a pin in that issue until a later time, then it’s really important that I know that.

My normal is not your normal, and vice versa. What's considered "normal" in your household might not fly in my household, and what's "normal" in your marriage could be unbearable for another couple. That's why normal is such a useless word to throw around, because it has too many meanings to actually mean anything significant. 

One of my pet peeves is when a parent says to me during an intake, "I just want him/her to be normal!". Ummm, and that means what?? 

Seriously, I need details over here. I do not have an intervention for "normal" behavior, nor do I know how to program for that.

Does ABA therapy seek to change individuals? Yes! Behavior change is the entire point of this therapy, either increasing appropriate, life benefiting, behaviors or decreasing inappropriate, harmful, behaviors. But Autism erasure should never be the goal of intervention.