Advocates worry that as HHS secretary, Robert F. Kennedy Jr. could undermine years of work to unlink autism and vaccines and divert precious research dollars to a discredited theory.
I mean see the much more involved reply I gave to the to other person but in addition to that the difference here is that ABA does work. It’s evidenced based to do so. It is not kooky bullshit of people stealing your money with snake oil.
The issue surrounding it is one of consent, which is a very worthwhile discussion to have. This is another issue with the way the article is presented. It confounds the actual issue! Now you are conflating it with snake oil when there is an astoundingly large body of evidence in support of its efficacy. To be clear, this is not a flimsy “it works sometimes under some scenarios maybe” thing. This is decades of evidence
So when you come into my practice and say you want to change a behavior that bothers you and negatively impacts your quality of life I can present you with operant conditioning. You want to change something about yourself, which is sometimes a thing that people do. It will likely be effective if done correctly. If I present it to you clearly and you consent to it, what’s the problem? But the moment I call it ABA you are far more likely to simply reject it now. That’s your right of course, but it’s sad
Now we can discuss the ethics of treating those who cannot reliably consent, children, people who cannot reliably communicate, etc. but frankly is ABA the issue here? Again I argue your issue is with programming direction being forced upon someone who cannot advocate for themselves. This is not ABAs fault. But it is an easier thing to scapegoat
I never claimed to not have bias. Everyone has bias. But I run my practice with a fairly extreme sliding scale, I take Medicaid, and I work with several clients for no money at all. I make a livable wage but I don’t make as much as you think. And the reason I do is because I do literally everything myself to cut as many middlemen and overheads as possible.
Additionally ABA is only a part of my practice. I do a lot of gender affirming care, CBT, etc. frankly if you removed ABA from my practice I would be fine, financially.
While it is valid and important to expose a vested financial interest I think it’s also important to look at the overall content of what is being displayed as well. Of course you have no obligation to do so and can always tell me to go fuck myself
It’s not like I get paid extra to do ABA. I get paid to do therapy regardless of who shows up and thanks to the shitshow of the world there’s no shortage of people. Mental health isn’t really like physical health. We can’t really “pad” billing with a ton of codes in outpatient settings most of the time. We bill in units, not services. So you come in and I bill more like you would expect from a worker, essentially by the hour. This is not like a surgeon that tacks on a complexity billing code and an extra code because you took a $300 Tylenol. Of course not all mental health is like this (especially crisis, which has more modifier codes)
But clearly you think regardless of how the billing works it doesn’t matter. So anyone who charges for their services is invalidated from speaking on issues? Got it. That is a viewpoint entirely incompatible with modern society. How do you reconcile such a thing?
Do you distrust vaccination because the evidence is sponsored by companies with a vested financial interest? Do you distrust the providers who recommend your flu shot because they have a vested financial interest in being able to bill for the service in rendering it? Do you distrust the evidence based treatments for your TN-2? There is a vested financial interest behind every treatment if you are that cynical.
A financial interest is absolutely something to investigate. That’s why they’re required to be disclosed in research. But it’s not inherently an issue if there is valid evidence of efficacy
I am criticizing their bias because their bias allows them to present a one sided inflammatory and misleading argument that masks the true issue of what the problem is here.
When someone comes into my job I give them the associated risks and rewards with ABA or any other therapy. They are allowed to weigh that risk and either consent or leave. Obviously my bias is that I think it is good. Like all people I have bias. But my bias is supported by a base of evidence supporting the efficacy of treatment
Again I think the issue here is consent and I think the article obfuscates that. If a parent comes in and says “my autistic child flaps their hands and that is weird, make them stop” it is my responsibility to say no. That is where I take offense to your point. If I was purely working from financial interest why wouldn’t I be like “fuck that kid?”. Granted there are practitioners out there who do this. I am sure of it. I am sure some of them are malicious even, knowing this is bad but doing it because they can bill. But I am betting the majority of them are more naive. They believe they are being helpful. They believe they are making this child’s life easier because it will help avoid social stigma, rather than think of ways to address causal factors of social stigma.
And to their credit they at least have an argument. I have worked with clients who wished they could suppress their stereotypy early in life to avoid bullying. I would argue these clients need work on self esteem and self advocacy rather than finding themselves in a position where they feel the need to be subservient to an abusive system only to make the abuse stop, but on the other hand it is not my right to tell someone how to interpret the world and this is starting to get away from the point.
But there is a very difficult ethical debate here. Where is the line for clients that cannot actively consent? A moral gray area exists, obviously. It’s easy to say that using ABA to extinguish non harmful stereotypy is fucked up. It’s somewhat easy to make the argument that someone who is physically harming themselves to the point of hospitalization would likely consent to changing their behavior (though obviously some will steadfastly disagree no matter what the risk is and regardless of the lack of viable alternatives). But where is the middle? What about doing homework? Chores? Moderating access to games and such? Far more interpretable
But we can’t have these nuanced discussions because of misleading articles like this and hardline stances like yours that reject any nuanced discussion on the topic whatsoever.
Edit: and that blog absolutely has a financial interest, they literally have a fucking shop link in their top bar. I have no idea if they run Adsense because I have Adblock. Their financial interest is more nefarious if anything! At least mine is upfront! I will tell you my hourly rate beforehand!
I mean see the much more involved reply I gave to the to other person but in addition to that the difference here is that ABA does work. It’s evidenced based to do so. It is not kooky bullshit of people stealing your money with snake oil.
The issue surrounding it is one of consent, which is a very worthwhile discussion to have. This is another issue with the way the article is presented. It confounds the actual issue! Now you are conflating it with snake oil when there is an astoundingly large body of evidence in support of its efficacy. To be clear, this is not a flimsy “it works sometimes under some scenarios maybe” thing. This is decades of evidence
So when you come into my practice and say you want to change a behavior that bothers you and negatively impacts your quality of life I can present you with operant conditioning. You want to change something about yourself, which is sometimes a thing that people do. It will likely be effective if done correctly. If I present it to you clearly and you consent to it, what’s the problem? But the moment I call it ABA you are far more likely to simply reject it now. That’s your right of course, but it’s sad
Now we can discuss the ethics of treating those who cannot reliably consent, children, people who cannot reliably communicate, etc. but frankly is ABA the issue here? Again I argue your issue is with programming direction being forced upon someone who cannot advocate for themselves. This is not ABAs fault. But it is an easier thing to scapegoat
You obviously have your own bias. And one with a financial incentive.
I never claimed to not have bias. Everyone has bias. But I run my practice with a fairly extreme sliding scale, I take Medicaid, and I work with several clients for no money at all. I make a livable wage but I don’t make as much as you think. And the reason I do is because I do literally everything myself to cut as many middlemen and overheads as possible.
Additionally ABA is only a part of my practice. I do a lot of gender affirming care, CBT, etc. frankly if you removed ABA from my practice I would be fine, financially.
While it is valid and important to expose a vested financial interest I think it’s also important to look at the overall content of what is being displayed as well. Of course you have no obligation to do so and can always tell me to go fuck myself
You have a financial incentive. The person you criticized about being really biased (and excusing yourself of the same thing) does not.
What difference does it make if you have a sliding scale? Do you think that makes shilling for your job acceptable?
To be clear i am not the person who downvoted you
It’s not like I get paid extra to do ABA. I get paid to do therapy regardless of who shows up and thanks to the shitshow of the world there’s no shortage of people. Mental health isn’t really like physical health. We can’t really “pad” billing with a ton of codes in outpatient settings most of the time. We bill in units, not services. So you come in and I bill more like you would expect from a worker, essentially by the hour. This is not like a surgeon that tacks on a complexity billing code and an extra code because you took a $300 Tylenol. Of course not all mental health is like this (especially crisis, which has more modifier codes)
But clearly you think regardless of how the billing works it doesn’t matter. So anyone who charges for their services is invalidated from speaking on issues? Got it. That is a viewpoint entirely incompatible with modern society. How do you reconcile such a thing?
Do you distrust vaccination because the evidence is sponsored by companies with a vested financial interest? Do you distrust the providers who recommend your flu shot because they have a vested financial interest in being able to bill for the service in rendering it? Do you distrust the evidence based treatments for your TN-2? There is a vested financial interest behind every treatment if you are that cynical.
A financial interest is absolutely something to investigate. That’s why they’re required to be disclosed in research. But it’s not inherently an issue if there is valid evidence of efficacy
I am criticizing their bias because their bias allows them to present a one sided inflammatory and misleading argument that masks the true issue of what the problem is here.
When someone comes into my job I give them the associated risks and rewards with ABA or any other therapy. They are allowed to weigh that risk and either consent or leave. Obviously my bias is that I think it is good. Like all people I have bias. But my bias is supported by a base of evidence supporting the efficacy of treatment
Again I think the issue here is consent and I think the article obfuscates that. If a parent comes in and says “my autistic child flaps their hands and that is weird, make them stop” it is my responsibility to say no. That is where I take offense to your point. If I was purely working from financial interest why wouldn’t I be like “fuck that kid?”. Granted there are practitioners out there who do this. I am sure of it. I am sure some of them are malicious even, knowing this is bad but doing it because they can bill. But I am betting the majority of them are more naive. They believe they are being helpful. They believe they are making this child’s life easier because it will help avoid social stigma, rather than think of ways to address causal factors of social stigma.
And to their credit they at least have an argument. I have worked with clients who wished they could suppress their stereotypy early in life to avoid bullying. I would argue these clients need work on self esteem and self advocacy rather than finding themselves in a position where they feel the need to be subservient to an abusive system only to make the abuse stop, but on the other hand it is not my right to tell someone how to interpret the world and this is starting to get away from the point.
But there is a very difficult ethical debate here. Where is the line for clients that cannot actively consent? A moral gray area exists, obviously. It’s easy to say that using ABA to extinguish non harmful stereotypy is fucked up. It’s somewhat easy to make the argument that someone who is physically harming themselves to the point of hospitalization would likely consent to changing their behavior (though obviously some will steadfastly disagree no matter what the risk is and regardless of the lack of viable alternatives). But where is the middle? What about doing homework? Chores? Moderating access to games and such? Far more interpretable
But we can’t have these nuanced discussions because of misleading articles like this and hardline stances like yours that reject any nuanced discussion on the topic whatsoever.
Edit: and that blog absolutely has a financial interest, they literally have a fucking shop link in their top bar. I have no idea if they run Adsense because I have Adblock. Their financial interest is more nefarious if anything! At least mine is upfront! I will tell you my hourly rate beforehand!