Anderson, M. (2007). Tales from the Table: Lovaas/ABA Intervention with Children on the Autistic Spectrum. Jessica Kingsley Publishers.
Oct 23, 2022
I read Tales from the Table: Lovaas/ABA Intervention with Children on the Autistic Spectrum by Margaret Anderson, so that you wouldn’t have to. This book expresses ableist attitudes in many ways, and some folks may find some of the materials discussed below quite stressful.
As criticism of ABA has become more mainstream, I have found that ABA practitioners are beginning to deny that some of the criticisms hold true. For example, ABA practitioners may claim they practice client-centered care or trauma-informed practice, or that they are not focused on normalization. Books like this – books about nonautistic perspectives on autistic people – hold some utility because of the way they formally document the worldview of a behaviorist.
The author promotes a 30- to 40-hour-a-week program of early intervention through discrete trial training (p. 10) and claims that autistic people respond better to early intervention than non-autistic people (p. 21). Families are described as going into substantial debt in order to pay for her program (p. 61). The ‘ABA tutors’ described in the book are unqualified and untrained – one is a 17-year-old who had taken a single ‘nursery class’ (p. 61, 99). The tutors themselves point out their pay is so low as to be “appalling” (p. 99). All of the autistic people described in the book were young boys, several of whom are described as having special interests in trains. In this way, the book works to maintain specific stereotypes about who autistic people are.
The author repeatedly refers to ABA as valid because of the research but doesn’t engage with the research itself or its conclusions (p. 22). ABA is simply presented as sciencey. The author engages very minimally with criticisms and analysis of the origins (in research!) of ABA as gay conversion therapy. She brushes it off in a short paragraph by pretending that because homophobia was prevalent in the 70s, it is “condescending” to look back on gay conversion therapy with disapproval (p. 118). Never mind that homophobia was a choice in the 1970s and there were significant gay rights movements active at the time.
Throughout the book, the author demonstrates her significant bias and ignorance about autism and autistic traits. For example, she places the study of autism within the “field of cognitive impairment” (p. 9) and quotes Bernard Rimland, an ableist figure who promoted the idea that autism is an intellectual disability (despite the rampant evidence that has always existed against this) (p. 21). She uses person-first language throughout but refers to the “autistic spectrum,” which, in a way, is kind of funny.
This book describes biomedical treatments uncritically, including chelation (p. 68), dosing children with the hormone secretin, leading to increases in aggression (p. 51), and restrictive diets that the children themselves did not choose or prefer, like gluten- and casein-free diets (p. 52, 67). The author often makes it clear that these children were happy to stop these diets because they enjoyed the foods their parents and therapists had restricted them from eating (p. 52). She also expresses her desire that science finds the “causes” of autism (p. 118).
Normalization has always been a key feature of ABA, and although many ABA practitioners attempt to diffuse criticism of their efforts of normalization through a range of responses–from denying normalization takes place to claiming that normalization is in the best interests of autistic people–it remains a core value of the approach. Normalization is a consistent theme in the intervention processes described, and the value of normalization, or being “indistinguishable from peers,” is challenged only when the author wants to praise herself for cases she worked on that did not become indistinguishable from their peers (p. 94). Not only does the author often use the phrase “indistinguishable from peers,” but she also refers to “ideal” autistics (p. 116)
From the very first pages to the very last, this book makes it clear that autistic people who are “indistinguishable from their peers” represent the “best outcome” (p. 8, 117). The author describes five young boys who need correction because they speak well but “oddly,” or because they use the wrong vocal tone (p. 29, 34).
A major theme is that autistic people cannot learn through conventional means and require discrete trial training (p. 22), and yet the author regularly points out that the children learned outside of discrete trial settings (p. 56). Non-injurious stimming, like flipping through the pages of a book, is consistently described as a problematic behavior that must be altered (p. 48, 91). Lining up toys is also seen as a problem that needs fixing (p. 49). The book emphasizes normalizing play and leisure skills; for example, in one case, the author seems to think it is very important that children play with dolls (p. 56).
Ironically, the book often describes these interventions as failing to transfer into the children’s daily lives, as they continued to prefer to play in their own autistic ways and only went along with the neurotypical play skills when they had no choice but to comply or be punished (p. 50, 53, 56, 57, 59, 71, 72, 74, 75).
The author does not seem to be aware of the double empathy problem. For example, Children are described positively when the author personally finds the child to be an “interesting conversational partner” (p. 30). The author never seems to care whether she herself is an interesting conversational partner to the autistic child. This common thread runs through every chapter of the book: autistic perspectives are never explored with any seriousness.
In one instance, it takes the author and parents years and years of coercing a child into neurotypical play before they realize they were only serving their own desires (p. 57). The author cannot translate this conclusion to other children described as similarly uninterested in using the skills being taught. The author even points out that some of the neurotypical play skills were ways of playing that the family and tutors were uncomfortable with – meaning adults and children were both uncomfortable and not enjoying themselves and yet were playing in that way due to the belief that it was “normal” and thus desirable (p. 72).
Many of the children are mentioned to have challenging behavior associated with being “physically low” or “ill health” (p. 42, 72, 73), and the response is consistently to maintain behavioral strategies like a token economy to address medical or physical issues. When all you have is a hammer, everything looks like a nail.
The author discusses the low self-esteem of one of the children (p. 37), with no insight into how getting 30-40 hours of adults constantly correcting the way you move, the way you talk, everything about you, taking data on your every move, and coercing you into acting “normal” and playing in the way that pleases others could impact a child’s self-esteem. Not only that, the author’s behavioral programs require verbal children to show a positive attitude about it all (p. 38).
The author is familiar with autistic advocacy on at least a very superficial level, but it is presented in this book as an afterthought. She does pay lip service to autistic activist authors and scholars like Jim Sinclair and Michelle Dawson; however, their autistic advocacy is never seriously engaged with, and on any occasions when it is acknowledged, it is just as quickly dismissed. In some cases, she dismisses autistic advocacy through a vague reference to “ideal autistics” (p. 116) without any seeming reflection on the consequences of creating a construct of an ideal disabled person.
It is hard to know what the author actually meant by using the phrase “ideal autistics” because she does not define this phrase. However, due to the context in which she was dismissing autistic advocacy that protests ABA, one likely interpretation is that the author is using the phrase “ideal” autistics as a sort of high-functioning/low-functioning dog whistle. When autistic people criticize ABA, a common reaction from ABA proponents is to claim that the autistic advocate who is criticizing ABA is too “high functioning” and that “low functioning” autistic people need ABA.
The author’s responses seem to fit into this common script, despite the fact that this book largely profiles children who are described as having ‘Asperger syndrome’ or “high IQ” or skills “above [their] age level” (p. 28, 29, 72). In one case, a child is described as having adult-level skills that exceed those of the tutor, causing the tutor to struggle to keep up with the child (p. 74).
The book makes it clear that ABA is a parent-centered therapy, not a client-centered or human-centered therapy. Autistic people are depicted as offering dangerous advice or not being capable of consenting or knowing what is best. Meanwhile, parents are described as inherently “gentle” people simply trying to bring their “beloved baby” into the world (pp. 18-19). These same parents are described as saying things like, if they had only had one child and their only child was autistic, they would be suicidal (p. 26) or as being disappointed with their autistic child because they responded to the world differently than expected (p. 26). Parents describe their positive feelings and yearning for the concept of ‘recovery’ from autism (p. 60, 63). When parents describe how ABA helped their child, they explain that it made the child easier for the parents rather than engaging in perspective-taking from the autistic person (p. 64). The author brushes aside issues of the harm of ABA by pointing out that parents legally consent to treatment and by casting aside the prevalence of child abuse by insisting all parents have their children’s best interests in mind (p. 118).
TL; DR – zero stars, would not recommend; this author does not understand autism.