The Meaninglessness of “Evidence-based”

The autism industry, among others, has rendered the term “evidence-based” meaningless.

I think we’re just going to have to let the term “evidence-based” go. There seems to be an inverse relationship between the extent to which a practice is described as evidence-based, and the quality of evidence supporting its use.

Source: Dr. Kristen Bottema-Beutel on Twitter

This is particularly true of behaviorism and ABA.

And if it turns out that, contrary to widespread assumptions, behavior modification techniques aren’t supported by solid data even when used with autistic kids, why would we persist in manipulating anyone with positive reinforcement? A rigorous new meta-analysis utterly debunks the claim that applied behavior analysis (ABA) therapy is the only intervention for children with autism that’s “evidence-based.” In fact, it raises serious questions about whether ABA merits that description at all.

You might assume that those who use the phrase “evidence-based practice” (EBP) are offering a testable claim, asserting that the practices in question are supported by good data. In reality, the phrase is more of an all-purpose honorific, wielded to silence dissent, intimidate critics, and imply that anyone who criticizes what they’re doing is rejecting science itself. It’s reminiscent of the way a religious leader might declare that what we’ve been told to do is “God’s will”: End of discussion.

Moreover – and it took me awhile to catch on to this – behaviorists often use “EBP” just as a shorthand for the practices they like, in contrast to the (progressive or humanistic) approaches they revile. It doesn’t matter if the evidence is actually weak or ambiguous or even if it points in the other direction. They’ll always come up with some reason to dismiss those inconvenient findings because their method is “evidence-based” by definition. (On social media and elsewhere, you can get a glimpse of how modern behaviorism resembles a religious cult – closer to Scientology than to science – with adherents circling the wagons, trading ad hominem attacks on their critics, and testing out defensive strategies to employ when, for example, people with autism speak out about how ABA has harmed them. Or when scholarship shows just how weak the empirical case for ABA really is.)

Which brings us back to that new research review. The work of eleven authors – including, interestingly, an ABA therapist – representing the University of Texas, Boston College, Vanderbilt, and Mount Holyoke, it was published in January 2020 in Psychological Bulletin (PB), a prestigious social science journal that specializes in lengthy integrative research reviews. The article is not a polemic. It does not consider, and appears not even to be informed by, any of the broader objections to ABA that are raised by autistic people or that I’ve raised here. It confines itself to describing peer-reviewed research. The authors cast a wide net, looking for every English-language study in the last half-century that compared an intervention group with a control group in treating children up to age 8 who had been diagnosed with Autism Spectrum Disorder. This yielded 1,615 separate results from 150 reports representing 6,240 participants.

The most striking finding in this research review is how few high-quality assessments of “the primary approach used in clinical practice” – that is, ABA – have ever been conducted. In fact, the great majority of ABA studies were so poorly designed that they didn’t merit inclusion in this review. Rather than comparing the results of different treatments for groups of children, behaviorist journals commonly publish single-subject studies, in which one child is assessed before and after treatment. (This method was invented by behaviorists back when their behavior-shaping efforts were limited to lab rats.) You don’t have to be a trained data analyst to see the serious limitations of this method in terms of the results’ lack of generalizability. For the authors of the PB review, these limitations were so glaring that it didn’t even make sense for them to bother with the results of single-subject studies. Yet those dubious results are the primary basis for behaviorists’ claims that ABA is “evidence-based.”

Source: Autism and Behaviorism – Alfie Kohn

It’s now often just marketing jargon. Practices that are accepted as evidence-based generally don’t have to try to sell themselves as evidence-based.

I’d be curious how many things labeled “evidence-based” are for profit.

Source: Noah Sasson on Twitter

I am likewise curious.

Previously,

Behaviorism: Measuring the Surface, Badly

Behaviorism only looks at observable behavior which can be measured. It doesn’t take into account thoughts, genetics, anxiety, trauma, health, or emotions because those things cannot be measured.

Source: Not an Autism Mom’s Thoughts on ABA: Part One » NeuroClastic

Ultimately behaviorism provides a simplistic lens that can’t see beyond itself.

Why is the doctrine of behaviorism still being used, at all?

How can ABA be the gold-standard for autism when it ignores everything we know about autism?

Source: Behaviorism is Dead. How Do We Tell The (Autism) Parents? » NeuroClastic

Assuming for the sake of argument that ABA is effective at changing people’s behavior, it either does so via changing their underlying thought structures or values (“deep change”), or it does not (“superficial change”). If ABA is “successful” by way of deep change, then ABA violates autonomy insofar as it coercively closes off certain paths of identity formation. If ABA is “successful” by way of superficial change, then ABA violates autonomy by coercively modifying children’s patterns of behavior to be misaligned with their preferences, passions, and pursuits. Such superficial change is a pervasive form of interference that compromises children’s present and future autonomy.

Source: Project MUSE – Ethical Concerns with Applied Behavior Analysis for Autism Spectrum “Disorder”

Plenty of policies and programs limit our ability to do right by children. But perhaps the most restrictive virtual straitjacket that educators face is behaviorism – a psychological theory that would have us focus exclusively on what can be seen and measured, that ignores or dismisses inner experience and reduces wholes to parts. It also suggests that everything people do can be explained as a quest for reinforcement – and, by implication, that we can control others by rewarding them selectively.

Allow me, then, to propose this rule of thumb: The value of any book, article, or presentation intended for teachers (or parents) is inversely related to the number of times the word “behavior” appears in it. The more our attention is fixed on the surface, the more we slight students’ underlying motives, values, and needs.

It’s been decades since academic psychology took seriously the orthodox behaviorism of John B. Watson and B.F. Skinner, which by now has shrunk to a cult-like clan of “behavior analysts.” But, alas, its reductionist influence lives on – in classroom (and schoolwide) management programs like PBIS and Class Dojo, in scripted curricula and the reduction of children’s learning to “data,” in grades and rubrics, in “competency”- and “proficiency”-based approaches to instruction, in standardized assessments, in reading incentives and merit pay for teachers.

But the enduring lesson for educators isn’t just that “positive reinforcement” turns out to be anything but positive. It also concerns the conceptual dead-end of behaviorism more generally. Every day, and with every child, we need to keep in mind that behaviors are just the protruding tip of the proverbial iceberg. What matters more than “What?” or “How much?” is “How come?”

Source: It’s Not About Behavior – Alfie Kohn

The underpinnings of that ideology include: a focus only on observable behaviors that can be quantified, a reduction of wholes to parts, the assumption that everything people do can be explained as a quest for reinforcement, and the creation of methods for selectively reinforcing whichever behaviors are preferred by the person with the power. Behaviorists ignore, or actively dismiss, subjective experience – the perceptions, needs, values, and complex motives of the human beings who engage in behaviors.

The late Herb Lovett used to say that there are only two problems with “special education” in America: It’s not special and it sure as hell isn’t education. The field continues to be marinated in behaviorist assumptions and practices despite the fact that numerous resources for teachers, therapists, and parents offer alternatives to behavior control. These alternatives are based on a commitment to care and to understand. By “care,” I mean that our relationship with the child is what matters most. He or she is not a passive object to be manipulated but a subject, a center of experience, a person with agency, with needs and rights. And by “understand,” I mean that we have an obligation to look beneath the behavior, in part by imaginatively trying to adopt that person’s point of view, attempting to understand the whys rather than just tabulating the frequency of the whats. As Norm Kunc and Emma Van der Klift urged us in their Credo for Support: “Be still and listen. What you define as inappropriate may be my attempt to communicate with you in the only way I can….[or] the only way I can exert some control over my life….Do not work on me. Work with me.”

It is nothing short of stunning to learn just how widely and intensely ABA is loathed by autistic adults who are able to describe their experience with it.

Source: Autism and Behaviorism – Alfie Kohn

PBIS.org focuses only on surface behavior, what one can observe. Whether this is due to lack of understanding of the complexity or an intentional omission is unknown. The focus on surface behavior, without seeming to understand or be concerned about the complexity, or even the simple dichotomy of volitional versus autonomic (stress response) and the use of outdated, compliance based, animal based behaviorism (which has no record of long term benefits) continues to fail our country’s students.

The documents on PBIS.org imply that all behavior is willful. There is no acknowledgement in the PBIS.org literature that behaviors can be stress responses (fight-flight-freeze responses). This is a profound omission that does great harm to children whose brains and bodies have highly sensitive neuroceptionof danger. To be punished for a stress response is harmful and traumatic.

The second concern about teaching replacement behaviors goes back to the lack of distinction between willful behaviors and stress behaviors. Teaching replacement behaviors is not possible for stress responses since they are automatic responses that occur beneath the level of conscious thought.

Source: The problem with behaviorism – Alliance Against Seclusion and Restraint

Behaviorism and ABA are superficial, misguided, and abusive. That the folks most able to feel the wrongness of behaviorism are the ones most subjected to it is immensely cruel.

If we were not threatening to the social order in some way, there would not be therapies designed to control how we move our bodies and communicate.

Source: THINKING PERSON’S GUIDE TO AUTISM: On Hans Asperger, the Nazis, and Autism: A Conversation Across Neurologies

Previously,

Behaviorist Ed-tech — Ed-tech from the 1940s

So, how on earth have we ended up with this many myths continuing painfully from one decade to the next?

I’m afraid the answer is that too much of the training has been stuck in the 1940s. Too much is done by non-autistic people, often ones who happen to know an autistic person in some way (maybe a relative) but seemingly have never asked them about life. I mean ‘asked’ in any communication sense, not just speech. Over a million autistic people in the UK, and too often, such trainers have none of them as personal friends, none of them as colleagues. Isn’t that odd?

Such trainers pass on the ancient myths, generation after generation. They write them down, put them on Powerpoint presentations, and deliver them to you as if they are fact. Research based in part on materials from the 1990s and 1980s, which was based largely on watching groups of profoundly disabled young men in a care home, as far back as the 1940s. As far removed from a balanced view of autism as one can get, in fact.

Worse still, they often expect you to pay for this. It might look slick, with excellent graphics, and the trainer might look like they could pose for a fashion magazine . But…are you really wanting 1940s material?

Source: Ann’s Autism Blog: Autism. Is your training from the 1940s?

The 1940s behaviorism of the autism industry has entered public education via ABA, PBS, Class Dojo, SEL data collection, mindset marketing, and other priorities of private equity. Get this 1940s material out of our schools. Mainstream ed-tech is taking us backwards.

Behaviorism commodifies people. It is the opposite of personalized learning.

Plenty of policies and programs limit our ability to do right by children. But perhaps the most restrictive virtual straitjacket that educators face is behaviorism – a psychological theory that would have us focus exclusively on what can be seen and measured, that ignores or dismisses inner experience and reduces wholes to parts. It also suggests that everything people do can be explained as a quest for reinforcement – and, by implication, that we can control others by rewarding them selectively.

Allow me, then, to propose this rule of thumb: The value of any book, article, or presentation intended for teachers (or parents) is inversely related to the number of times the word “behavior” appears in it. The more our attention is fixed on the surface, the more we slight students’ underlying motives, values, and needs.

It’s been decades since academic psychology took seriously the orthodox behaviorism of John B. Watson and B.F. Skinner, which by now has shrunk to a cult-like clan of “behavior analysts.” But, alas, its reductionist influence lives on – in classroom (and schoolwide) management programs like PBIS and Class Dojo, in scripted curricula and the reduction of children’s learning to “data,” in grades and rubrics, in “competency”- and “proficiency”-based approaches to instruction, in standardized assessments, in reading incentives and merit pay for teachers.

It’s time we outgrew this limited and limiting psychological theory. That means attending less to students’ behaviors and more to the students themselves.

Source: It’s Not About Behavior – Alfie Kohn

We cannot replace agency with response to stimuli.

Source: MMCP: Critical Digital Pedagogy; or, the Magic of Gears | Hybrid Pedagogy

I am watching the US education system not very subtly invite punishment back into the mainstream classroom. This appears to be driven by the field of Applied Behavioral Analysis (ABA).

Source: Defining Reinforcement and Punishment for Educators – Why Haven’t They Done That Yet?