COFAR blog

John Summers, a writer with whom we frequently correspond on disability issues, is a Cambridge parent who followed recommendations from doctors to seek Applied Behavior Analysis (ABA) services for his developmentally disabled son Misha.

ABA is the primary form of clinical treatment in Massachusetts and around the country for persons with developmental disabilities, and particularly for children with autism.

But in an essay he wrote for the Ideas section in this coming Sunday’s edition of The Boston Globe, Summers, who is a Research Fellow in History and Disability at New America, gives a compelling and moving account of how ABA failed his son, and how both of them finally broke free of it.

One of Summers’ key criticisms of the ABA system in Massachusetts and other states around the country stems from his finding that no state agency collects data on ABA. “It makes no sense,” he said in an email to us. “They are running a collective experiment on these children and not asking for any results. Given the state’s history with disability, that’s troubling.”

Summers wrote to us that MassHealth’s spending on ABA jumped 200% between 2017 and 2021. MassHealth began funding ABA services in 2017. In Fiscal Year 2021, he said, MassHealth spent $140.5 million on ABA services for 6,227 clients, for an average cost per child of $22,563.

“Yet,’ he wrote, “Massachusetts isn’t trying to find out what escalating public investment in this treatment is achieving, much less what harm it may be doing.”

We would be interested in hearing from our members as to their experiences with ABA for their loved ones in the DDS and special education systems. It’s possible that many clients have been helped by it. Summers says that for Misha, it was a futile ordeal.

Summers had placed his son, who is now 11, in ABA programs from the time Misha was just under two years old. Mishas was steered there, Summers said, by his Early Intervention program. Yet somehow, the years of treatment didn’t seem to be helping him.

ABA school attempted to quash essay

Summers said that Melmark New England, one of the ABA schools that he discusses in his Globe essay, hired Regan Communications, the powerful Boston public relations firm, to try to prevent the Globe from publishing his essay. Ultimately, Melmark was unsuccessful in stopping publication of the article.

“It was a revealing move,” Summers says, “that betrays a lack of compassion behind the smiling corporate face.”

ABA based on the theories of B.F. Skinner

A couple of years ago, Summers writes in his essay, he began doing research on ABA. He found that it stems from the behaviorist school of psychology, which was pioneered in the 1950s and 1960s by B.F.Skinner. Skinner engaged in what Summers describes as a “revolt against the traditional subject matter and methods of psychology.”

Summers notes that under the behaviorism model, “the inner life of motivation and sensation, will and judgment, thought and feeling” are disregarded because they can’t be measured. Those things lack what Skinner described as “the dimensions of physical science.”

As Summers put it, Misha’s behavior analysts “restricted themselves to observing his physical operations, devoid of subjective or personal meaning, so that they could be measured with the same tape, as it were.” In sessions that could last several hours a day, Misha’s behaviors deemed appropriate were rewarded by “reinforcers” such as gold stars. Negative reinforcers such as withholding attention were used for his behaviors that were deemed inappropriate.

But failing by the ABA measuring tapes to make expected progress in an ABA school in Cambridge, Misha was sent to a Melmark school in Andover. According to Summers, “Melmark clamped a vise grip around him.” In an observation room, “behind a one-way mirror, an ‘educational coordinator’ monitored his compliance with ‘appropriate social interactions’ in class.”

Still, none of it worked. The program wasn’t able to teach Misha how to brush his teeth, speak, or read at the level of children his age. Yet, the rigidity of the program’s methods frustrated Misha who engaged in bouts of crying and tearing out his hair there.

Summers had seen enough. In March, he enrolled Misha in the Perkins School for the Blind in Watertown, which agreed to “scrub every trace of ABA from his IEP (Individual Education Plan).”  Misha still can’t brush his teeth without help, but he is finally in a program that he enjoys and where he is given the freedom to have what Summers describes as an inner life.

Behaviorism largely debunked

Summers notes in his Globe essay that behaviorism is no longer an influential school in the field of psychology. One of the few areas it is still practiced is in the treatment of persons with developmental disabilities. In those school settings, autistic students are largely segregated from the rest of society.

It’s ironic because states such as Massachusetts, which rely on ABA, nevertheless subscribe to an ideology that congregate care for people with I/DD is universally bad because it segregates them from the wider community. Of course, that ideology leads to all kinds of contradictions, particularly the mistaken assertion that small group home settings are fully integrated into the community.

Private equity takeover of some ABA schools

Summers also told us that his research has revealed that because ABA schools have become so widely supported by government funding, the schools have increasingly become a focus of investment by private equity firms.

Summers said that of the total of 92 ABA schools certified by Early Intervention in Massachusetts, he found that at least five are owned by private equity companies. He said he asked the Massachusetts Department of Public Health (DPH), the lead administrative agency for Massachusetts Early Intervention programs, “whether they were concerned about this, but received no answer.”

Summers said the five ABA schools he found to be owned by private equity firms are Key Autism Services (owned by Cane Investment Partners); Butterfly Effects (Moran Capital Partners); Autism Spectrum Therapies / LEARN Behavioral (Gryphon Investors and PineBridge Investments); Behavioral Healthworks (TA Associates); and Mentor South Bay (Sevita).

As noted, we would welcome your comments about your experiences with ABA.