Beyond Compliance: A Social Work Perspective on Abolishing ABA and Embracing Neurodiversity

Introduction

Applied Behavior Analysis (ABA) has long been heralded as the “gold standard” therapy for autism, yet it faces growing scrutiny over ethical and practical implications for autistic individuals. ABA’s behaviorist roots lie in operant conditioning – shaping behavior via rewards and punishments – with early pioneers like O. Ivar Lovaas aiming to make autistic children “indistinguishable from their peers” . While many parents and professionals credit ABA with teaching skills and reducing challenging behaviors, autistic self-advocates and an increasing body of research raise serious concerns. They argue that ABA’s compliance-based drills and normalization goals can infringe on autistic children’s autonomy and well-being  . Reports of children later developing PTSD symptoms after intensive ABA , along with testimonies of trauma and “masking” (camouflaging one’s autistic traits to appear neurotypical), have spurred a reevaluation of ABA through a neurodiversity and social work lens. Social workers, guided by values of dignity, self-determination, and social justice, are uniquely positioned to assess whether autism interventions truly serve the client’s best interests. This paper provides a critical overview of ABA’s history and impact, examines ethical concerns including compliance-driven practice, masking, and trauma, and explores alternative neurodiversity-affirming approaches. A comprehensive literature review (focusing on the last five years) informs an analysis of how therapies like DIR/Floortime, SCERTS, and occupational therapy can promote autonomy, mental health, and self-directed growth for neurodivergent individuals. Finally, policy recommendations and practical applications are offered for social workers to support autistic clients in ways that respect neurodiversity and avoid harmful practices. Aligning with neurodivergent perspectives and current research, the discussion underscores the need for systemic change in autism services – and the vital role of social workers in advocating for ethical, inclusive, and trauma-informed supports.

History of ABA and Its Behaviorist Foundation

ABA therapy emerged from mid-20th-century behaviorism, a psychology paradigm asserting that observable behavior (not internal thoughts or feelings) is the primary unit of study. B.F. Skinner’s operant conditioning demonstrated that behavior could be shaped through reinforcement. In the 1960s, Dr. Ivar Lovaas applied these principles to autistic children at UCLA, launching the first intensive ABA-based autism intervention program . Lovaas’s early work was highly controlled: children received hours of trials where desired behaviors (like responding to one’s name or making eye contact) were rewarded, and undesirable behaviors (such as self-stimulation or “stimming”) were discouraged through reprimands or aversives. Notably, Lovaas also infamously participated in “conversion therapy” experiments to discourage feminine behaviors in young boys, reflecting a troubling ethical overlap between early ABA and attempts to enforce social norms in other domains . This “brutal beginning,” as autistic advocates describe it, included the use of aversives like electric shocks and slaps in some cases . Such methods were controversial even then, but Lovaas reported striking results: in a 1987 study, about 47% of children who received 40 hours per week of ABA for two years achieved “indistinguishable” functioning in regular classrooms . This claim – that nearly half of treated children ostensibly “recovered” – captured public imagination and led to ABA’s reputation as a breakthrough. By 1999, the U.S. Surgeon General’s report touted ABA’s efficacy with decades of research support . ABA became institutionalized as the default autism therapy, often prescribed at 20–40 hours a week of one-on-one behavior training.

However, ABA’s history is marred by ethical issues. Early ABA practitioners often prioritized behavioral compliance over the child’s emotional state. Lovaas was quoted as saying that “you start pretty much from scratch” with an autistic child, likening them to an object to be molded – a dehumanizing perspective that ignored the child’s agency (Szalavitz, 2016, as cited in Devita-Raeburn, 2016). Additionally, some ABA programs administered painful or fear-inducing stimuli as punishments (so-called “aversives”), a practice that persists in rare settings today – for example, the use of electric shock aversives at the Judge Rotenberg Center has been condemned as torture by the United Nations. The behaviorist foundation of ABA, with its focus on observable behavior and external control, set the stage for a fundamental clash with the emerging neurodiversity paradigm, which views autism as a natural variation rather than a defect to be cured. This historical context is crucial for understanding why many autistic people and allies argue that ABA’s core goal of normalizing autistic individuals is misguided and harmful  . As we shall examine, the legacy of ABA’s origins raises lasting ethical questions that modern iterations of the therapy continue to grapple with.

ABA’s Compliance-Based Approach and Ethical Concerns

A central ethical concern is ABA’s emphasis on compliance – training the child to obey instructions and perform tasks without protest. Traditional ABA programs use discrete trial training and prompting to elicit correct responses, reinforcing compliance with rewards (e.g. treats, praise) and discouraging refusal or escape. Wilkenfeld and McCarthy (2020) argue this dynamic can violate a child’s autonomy and right to consent . Children in ABA often have little say in their activities; their attempts to avoid a task (crying, walking away, “tantrums”) may be seen as behaviors to extinguish rather than as communication. For example, if a child tries to leave a training table, the therapist might use escape extinction – preventing the child from leaving until they comply – which effectively teaches that “no” is not an option. Such compliance training raises serious ethical issues. It conditions vulnerable children to ignore their own discomfort and always defer to authority, potentially increasing their risk of abuse in other contexts since they are rewarded for unquestioning obedience. As one bioethics analysis noted, even if ABA today relies mostly on positive reinforcement, the act of withholding a reward until a child obeys can itself cause distress and coercion . Over time, relentless pressure to comply can erode the development of self-advocacy skills. Autistic advocates frequently recount being taught in ABA that their natural reactions were “wrong,” instilling an unhealthy belief that authority figures must always be obeyed. This directly conflicts with social work values of self-determination and empowerment. From a social work lens, any intervention that systematically ignores a client’s dissent or communication of discomfort is problematic – it infringes on the client’s dignity and bodily autonomy. The NASW Code of Ethics emphasizes a client’s right to self-determination; yet ABA’s compliance model, as typically practiced, leaves little room for the child’s preferences or consent, effectively “removing autonomy” (Autistic Self Advocacy Network, 2021) from the equation.

Research and first-hand accounts have linked this compliance-focus to negative outcomes. Kupferstein (2018) surveyed hundreds of autistic adults and parents and found that nearly half (46%) of those exposed to ABA in childhood met the clinical threshold for post-traumatic stress disorder (PTSD) . ABA-exposed individuals were 86% more likely to exhibit PTSD symptoms relative to non-exposed peers . While this study relied on self-reported data and has limitations, its findings align with a flood of anecdotal reports that intensive ABA can be traumatic. The trauma often stems from the powerlessness and sustained stress many children experience: being forced through drills despite crying or meltdowns, having their benign self-soothing behaviors suppressed, or even enduring harsh punishments in some cases. One adult autistic advocate described ABA as “compliance training at the cost of my mental health”, noting that constantly suppressing her true reactions led to anxiety and trauma in later life (Sequenzia, 2016). The ethical principle of nonmaleficence – do no harm – appears to be violated when a therapy leaves a large minority of its recipients with trauma-related symptoms . Social workers must heed these red flags, as we have a duty to ensure interventions promote overall well-being and do not inflict psychological harm.

Another ethical critique is ABA’s historical goal of normalization, which can enforce masking and undermine identity. Lovaas’s aim of making autistic children “indistinguishable from their normal friends” set a precedent that success = acting neurotypical . Many ABA programs still explicitly or implicitly pursue this outcome by targeting behaviors that mark the child as autistic – for instance, hand-flapping, rocking, atypical vocalizations, or intense special interests. These behaviors (often called “stereotypy” or “restricted interests”) are typically harmless expressions of an autistic person’s neurology. Yet in ABA, they have often been labeled “inappropriate” and subjected to reduction protocols. Autistic self-advocates argue that suppressing these natural behaviors sends a damaging message: that their authentic self is wrong and must be hidden. Research on camouflaging (masking) in autism shows it correlates with increased anxiety, depression, and even suicidality . Ne’eman (2021) emphasizes that outcome measures for autism therapies should not center on making people “pass” as neurotypical, as this “often interferes with more meaningful, person-centered goals and causes harm”  . Indeed, forcing autistic individuals to constantly mask their traits can create chronic stress. One study found that the effort of camouflaging was associated with heightened mental health challenges and burnout in autistic adults . By prioritizing compliance with social norms over the client’s comfort, ABA may inadvertently contribute to long-term psychological distress. From a social work perspective, this is antithetical to promoting positive mental health and self-acceptance. Social workers in autism care have observed that interventions solely focused on surface behaviors “often ignore the stress that passing for normal places on people with disabilities” . Thus, the impact on autistic individuals’ mental health is a key consideration: interventions must be evaluated not just on immediate behavior change, but on how they affect the person’s emotional well-being, identity, and rights.

Masking and “Indistinguishability” – Autistic Voices on ABA

Listening to autistic individuals reveals how ABA’s techniques can foster masking. Many autistic adults who underwent ABA report that they learned to appear outwardly “normal” at great internal cost. For example, they may have been trained to make eye contact even though it caused them pain or anxiety, or to stay silent and still when they were upset because expressing distress was consistently discouraged by therapists. Over years, these children become adept at suppressing their natural responses – a form of camouflage. While this might look like “progress” externally, internally it can be deeply damaging. Milton (2012) introduced the “double empathy problem,” noting that the communication gap between autistic and non-autistic people is mutual – expecting only autistic people to change creates a one-sided burden. ABA historically placed that full burden on the autistic child: they had to adjust to the world, rather than the world accommodating their differences.

Autistic activists frequently compare ABA to gay conversion therapy, in that both attempt to train an individual to hide fundamental aspects of themselves to fit societal expectations . Amy Sequenzia, a nonspeaking autistic advocate, bluntly calls ABA “autism conversion therapy” . The Autistic Self Advocacy Network (ASAN) similarly argues that ABA’s core premise – erasing autistic traits to produce a neurotypical-appearing child – is ethically unacceptable . They point out that even if modern ABA uses gentler methods than Lovaas’s day (no more electroshocks or yelling in most settings), the underlying goal in many programs remains behavior normalization, which autistic people experience as a form of erasure . This critique dovetails with the social model of disability, which posits that disability is created by societal barriers and biases rather than deficits inherent in the person. From a social model or neurodiversity standpoint, therapies should focus on removing barriers and supporting the person, not forcing the person to “mask” their differences to appease others. Social work, with its emphasis on person-in-environment and social justice, aligns with this view. It calls for interventions that validate the client’s identity and work to change oppressive environments, rather than changing the client to fit a narrow norm.

The ethical principle of justice is also relevant – ensuring equitable treatment and honoring the humanity of autistic individuals. For decades, ABA was often implemented without input from autistic people themselves (most practitioners and decision-makers were non-autistic). This marginalization of autistic voices meant that measures of success were defined by neurotypical standards (e.g., speaking verbally, playing in typical ways) rather than the goals and values that autistic people might choose for themselves . In recent years, autistic self-advocacy has pressured the ABA field to confront this lack of stakeholder participation. There are calls to involve autistic adults in designing therapies, conducting research, and setting goals – a practice consistent with the social work mandate to involve clients in decisions about their care. The NASW Disability Ethics note that clients with disabilities should be treated as experts on their own experiences; ignoring autistic expertise (for example, dismissing an autistic adult’s critique of ABA because they lack professional credentials) is both unethical and poor practice  . Encouragingly, some ABA researchers now acknowledge that “autistic individuals have unparalleled expertise in their own lives” and that their concerns “cannot, morally or ethically, be swept aside”  . In summary, the push to end masking and respect autistic identity is fundamentally about recognizing autistic people’s right to exist as themselves without therapy aiming to “fix” their personality. The social work lens reinforces that any practice reducing a person’s identity to a list of behaviors fails to see the whole person and may inadvertently perpetuate harm.

Trauma and Lasting Impacts of ABA

ABA’s intensive nature – often 20 to 40 hours per week of therapy starting in toddlerhood – means it occupies a huge portion of a young autistic child’s life. Critics note that this leaves little time for the child to engage in natural play, family bonding, or rest . The time intensity itself can be detrimental; one could liken it to a full-time job imposed on a toddler. Wilkenfeld and McCarthy (2020) highlight that every hour spent in rigid ABA drills is an hour not spent in more child-led activities that foster creativity and joy . There is an opportunity cost to such early interventions. If the therapy is respectful and fun, high intensity might be justified, but if it’s stressful, the prolonged exposure can compound trauma. The aforementioned study by Kupferstein (2018) suggests that trauma is not an uncommon outcome . The qualitative reports behind those statistics are heart-wrenching: adults describe ABA sessions where they were held in chairs, denied affection, or had cherished toys removed for days to “shape” their behavior. Some recall being punished for crying or for performing self-stimulatory calming actions, leading to a learned helplessness where they no longer cried when hurt. This kind of conditioned compliance is essentially trauma bonding; the child learns that showing pain won’t result in comfort, so they stop showing it. Such conditioning can have lifelong consequences on attachment and mental health.

Even without overt aversives, ABA can create aversive experiences through sensory overwhelm or emotional strain. Many autistic children have sensory processing differences; a busy ABA clinic or a strict table-top session can assault their senses (bright lights, touching, constant demands) – yet if they react or try to escape, the behavior program might treat that as “non-compliance” to work through. For a child who is already navigating a world not built for their neurology, an intense therapy that doesn’t accommodate their sensory and emotional needs can become a source of chronic stress. Trauma-informed care principles would demand adjusting or halting an intervention at signs of extreme distress, but historically ABA’s philosophy was to push through an “extinction burst” (where a behavior escalates when reinforcement is removed) to reach the desired behavior. Without careful oversight, this can tip into emotional abuse, albeit under the guise of therapy. The ethical alarms raised by these scenarios are clear: no treatment, however well-intentioned, should sacrifice a child’s emotional security and trust. As social workers, we must ask “for whose benefit” is this intervention – the child’s, or the comfort of others who want the child to appear normal? If an autistic child is being traumatized to achieve compliance or a façade of normalcy, the intervention violates both beneficence (promoting well-being) and nonmaleficence.

It is important to note that not every ABA program is identical today. The field, under pressure from autistic advocates and evolving ethical standards, has begun to adapt in some quarters. Some contemporary ABA providers claim to use a “kinder” ABA: no aversive punishments, incorporating choice-making, and focusing on functional skills (like communication) rather than suppressing harmless behaviors. There is evidence of shifts – for instance, certain agencies no longer target hand-flapping or atypical play for elimination, recognizing these as benign  . A recent article by behavior analysts acknowledges many of the critiques and suggests that listening to consumers’ (autistic clients and families) feedback is essential to improve practice . They concede that concerns about consent violations, dignity, and focus on normalization are valid and must be addressed for ABA to align with ethical standards  . This is a welcome development. However, critics argue that unless the fundamental goal of “making the child normal” is abandoned, these are only surface-level changes. The Neurodiversity Movement within and outside the ABA field posits that true reform would mean shifting the purpose of intervention: away from drilling behavioral compliance and toward supporting the child’s own goals, communication, and emotional development  . In other words, a transformation from therapist-led compliance training to client-centered skill-building and coping strategies.

Neurodiversity-Affirming Alternatives

In light of ABA’s contentious aspects, many families and professionals are exploring alternative therapies that align with the neurodiversity paradigm. Neurodiversity-affirming approaches accept autism as a lifelong neurodevelopmental difference and prioritize helping the individual thrive as themselves, rather than molding them to neurotypical norms. These approaches emphasize autonomy, sensory and emotional well-being, and self-directed growth. Several notable alternatives include DIR/Floortime, the SCERTS model, and strengths-based occupational therapy; each offers a contrast to ABA’s compliance-driven style.

DIR/Floortime: The Developmental, Individual-Differences, Relationship-Based model (DIR), commonly known as Floortime, was developed by Stanley Greenspan and Serena Wieder as a play-based approach to support autistic children. Floortime is explicitly child-led – the therapist or parent joins the child on the floor, follows the child’s interests (whether that’s spinning a toy, lining up cars, or any activity the child enjoys), and uses those moments to create shared engagement and foster development. Instead of trying to redirect the child’s focus to therapist-chosen tasks, Floortime positions the child’s attention and motivation as the starting point for learning. Over time, the adult “floors” (gets down to the child’s level both physically and emotionally) and gently expands the interaction: for example, if a child is spinning a wheel, the adult might spin another wheel alongside and smile, vocalize, or otherwise invite the child to connect. This approach respects the child’s autonomy and passions – rather than extinguishing a “perseverative” interest, it joins it and builds from it. Floortime also targets emotional regulation by meeting the child in their emotional state and co-regulating (soothing or energizing as needed through play). Research into Floortime is growing. A systematic review by Boshoff et al. (2020) found that across nine studies, DIR/Floortime-based interventions led to improved socio-emotional development in autistic children, particularly when parents were involved . Children showed gains in social interaction skills and emotional reciprocity – outcomes aligned with quality of relationships – even if core language or cognitive skills showed minimal change . These findings underscore that Floortime helps children engage and relate, rather than simply perform tasks. Importantly, Floortime is completely child-led and play-driven, which likely makes it more enjoyable and less traumatic for the child  . Parents report high satisfaction, noting that it helped them understand and bond with their child rather than feeling like they must “fix” them. While the evidence base for Floortime is still emerging (and more rigorous trials are needed to conclusively demonstrate its effects ), it is widely regarded as a respectful and developmentally appropriate therapy. From a social work perspective, DIR/Floortime is appealing because it inherently honors the child’s dignity and choices – the practitioner works with the child’s intrinsic interests, not against them. This aligns with empowering practice and avoiding coercion.

SCERTS Model: Another neurodiversity-aligned approach is the SCERTS model, which stands for Social Communication, Emotional Regulation, and Transactional Support. SCERTS is not a specific therapy technique but a comprehensive framework for educating and supporting autistic children. Developed by Barry Prizant and colleagues, SCERTS emphasizes helping the child communicate and regulate emotions in everyday routines, with a strong focus on adapting the environment and educating communication partners (parents, teachers) – these adaptations are the “Transactional Support” component. The model’s priorities (social communication and emotional self-regulation) naturally steer away from rote compliance drills. For example, instead of drilling a child to say “hello” on command, a SCERTS-based program might work on the child’s preferred method of communication (words, pictures, device, or gestures) to express needs or feelings, and on strategies to calm themselves (with adult support) when overwhelmed. The approach is holistic and multidisciplinary by design, often involving speech-language pathologists, occupational therapists, educators, and parents working from the same playbook. An important principle is addressing the child as a whole person rather than a set of discrete behaviors . By coordinating goals across settings and focusing on functional communication, SCERTS aims to build skills that truly matter to the child’s daily life (e.g., being able to indicate “I need a break” or to recover from an upset) rather than simply reducing autism symptoms. Evidence for SCERTS is also accumulating. A pilot study in Hong Kong with over 120 children found that a SCERTS-based intervention led to significant improvements in social communication and emotional regulation skills, with parents and educators reporting positive feedback . Moreover, a 2022 systematic review by Yi et al. analyzed multiple SCERTS studies and concluded that SCERTS shows promising efficacy in promoting social communication and can be implemented with fidelity by practitioners after training . The review noted that evidence for other areas (language gains, repetitive behaviors reduction) was mixed or limited, calling for more research   – but importantly, the core domains of SCERTS (social communication and regulation) did see generally positive outcomes. The SCERTS model is inherently neurodiversity-affirming: it does not view autistic behaviors as inherently bad, but rather as signals of needs or attempts at communication. For instance, “restricted” interests might be used as entry points for connection, and atypical communication (like echolalia or scripting) is acknowledged as communication to be built upon, not extinguished. Social workers can appreciate SCERTS’s consistency with strengths-based practice – it builds on the child’s existing strengths (special interests, nonverbal communication, etc.) and adds supports to address challenges (sensory supports, visual schedules, emotional coaching), ultimately aiming for the child’s greater autonomy and participation in their social worlds.

Occupational Therapy (OT) with a Neurodiversity Lens: Occupational therapy for autistic individuals often focuses on developing daily living skills, motor coordination, and managing sensory needs. Traditionally, some OT approaches (like certain sensory integration techniques) were adult-driven, but there is a significant movement within OT towards neurodiversity-affirming practice. This involves recognizing the autistic person’s sensory and cognitive profile as a valid way of experiencing the world and working collaboratively to enhance comfort and functional skills without trying to make them “normal.” A recent study by Sterman et al. (2023) specifically sought input from autistic adults about their experiences with pediatric OT and their recommendations for improving OT services for children  . The autistic adults overwhelmingly valued therapy that supports autistic identity rather than trying to “fix” the child . They advocated for therapists to adapt environments and tasks to the child (for example, using noise-cancelling headphones or allowing movement during activities) instead of forcing the child to suppress their autistic traits. They also emphasized setting goals around self-advocacy and autonomy, such as teaching the child to communicate their needs (e.g., asking for a break, advocating for preferences) . In practice, a neurodiversity-aligned OT session might look like helping a child find comfortable ways to do daily tasks – if a child is overwhelmed by bright lights when dressing, the OT might suggest dimmer lighting or sunglasses rather than insisting the child “get used to it.” If handwriting is painfully slow due to fine motor issues, the OT might introduce keyboarding or speech-to-text early, recognizing that accommodating the child’s difference is more empowering than trying to force a typical skill that causes distress. The goal shift here is crucial: success is measured by the child’s functional happiness and participation, not by appearing non-autistic. OT is a broad field, but at its best, it upholds the mantra “modify the environment, not the person.” The American Occupational Therapy Association’s new practice guidelines for autistic people stress promoting self-determination, inclusion, and mental health, and caution against interventions that pathologize harmless behaviors or impose neurotypical standards (AOTA, 2023). For social workers, collaborating with OTs who use this approach can be very fruitful. It provides families with practical strategies to support their child (e.g., sensory toolkits, visual aids for routines) that do not inflict trauma or suppression. It also models an attitude of acceptance: showing parents that rather than battling their child’s autism, they can join their child’s world, accommodate needs, and celebrate progress on the child’s own terms.

Other neurodiversity-affirming supports include speech-language therapy that prioritizes communication over speech (for non-speaking autistics, this might mean embracing augmentative communication methods like communication devices or sign language instead of forcing verbal speech), social skills groups led by autistic adults (providing mentorship in a way that respects autistic social styles), and counseling or cognitive behavioral therapy adapted for autistic thinking (to address anxiety or emotional challenges without trying to change personality). Approaches such as PBS (Positive Behavior Support) have also gained traction; PBS shares roots with behavior analysis but emphasizes understanding the function of behaviors in context and modifying the environment to prevent challenging behaviors, rather than conditioning the individual. It typically involves person-centered planning and is aligned with empowering the individual and family. While not explicitly framed as neurodiversity movements, PBS and related approaches represent a gentler evolution of behavioral practice focused on quality of life outcomes rather than normalization.

It should be acknowledged that alternatives like Floortime and SCERTS have faced criticism about evidence base – some proponents of ABA argue these approaches are not as extensively validated by research as ABA. Indeed, ABA’s decades of research often focus on quantifiable behavioral outcomes, whereas measuring the success of developmental or relationship-based models can be more complex (how to quantify improved emotional connection or reduced trauma?). However, as the paradigm shifts toward more humane goals, researchers are developing new metrics – for example, measures of quality of life, personal goal attainment, and mental health – to evaluate outcomes that matter to autistic people  . Recent years have seen more studies focusing on family satisfaction, the child’s affect during sessions (happy vs. distressed), and long-term well-being. From a social work research perspective, these holistic outcomes are just as important as IQ points or adaptive behavior scores. Leadbitter et al. (2021) argue that autism intervention research must “reframe effectiveness” by incorporating autistic people’s priorities and moving away from a strictly normative agenda . They call for intervention studies to consider outcomes like autistic well-being, coping strategies, and autonomy rather than just reduction of diagnostic traits  . This reflects a broader ethical research trend: involving the community being researched as partners (community-based participatory research), which is well-aligned with social work scholarship.

Policy and Advocacy: Social Work’s Role in Ethical Autism Support

Given the ethical concerns outlined, social workers have a critical role in shifting autism services toward more ethical, neurodiversity-affirming practices. This requires action at multiple levels – individual practice, agency policy, and broader systemic advocacy. Below are key recommendations and applications for social workers:

• Empower Informed Choice for Families: Social workers often serve as advisors or case managers for families after an autism diagnosis. It is vital to provide families with balanced, evidence-informed information about intervention options – not only ABA (which is often heavily marketed as the only effective therapy) but also alternatives like developmental and educational approaches. Too often, parents feel pressured to enroll their child in intensive ABA immediately or risk missing a narrow “window” for improvement. Social workers can counter this by sharing research on child-led and relationship-based approaches, explaining that while ABA has been commonly used, there are other viable therapies that may better respect the child’s needs and autonomy  . They should discuss potential ethical drawbacks of any intervention – for example, explaining what compliance training entails and its possible emotional toll – so that parents can make truly informed decisions. By demystifying neurodiversity-affirming approaches (which some pediatricians may not even mention), social workers broaden the menu of choices. In practice, a social worker might help a family connect with a Floortime play consultant, or an occupational therapist with sensory integration expertise, especially if the family or child is uncomfortable with ABA. The goal is not to “steer” parents away from any specific therapy, but to ensure they are aware that they have options and that one size does not fit all. A family’s culture, the child’s temperament, and specific needs should guide the choice of supports – a principle in line with person-centered planning.

• Advocate for Client-Centered Goals and Consent in IEPs and Plans: Social workers working in schools or clinics can influence the goals set in Individualized Education Programs (IEPs) or treatment plans. Rather than defaulting to goals like “reduce stimming” or “maintain eye contact for 5 seconds,” social workers can push for goals that enhance the child’s actual functioning and self-advocacy (e.g., “child will use a break card or sign to request a break when overstimulated” or “child will increase communication of needs, via speech or device, in classroom routines”). This shifts the focus from compliance to communication and coping skills. Additionally, social workers should ensure that child consent and assent are built into behavioral plans. For example, if a behavior plan involves physical prompting or any restrictive strategy, does the child have a way to signal “no” or “stop” that will be honored? We should insist that programs incorporate assent withdrawal protocols – if a child is clearly objecting or in distress, the intervention should pause and recalibrate  . Recent neurodiversity-oriented ABA literature even suggests reinforcing a client’s use of an “I need a break” signal and honoring it . Social workers can monitor that this actually happens on the ground. In essence, every autistic child – even those with limited communication – has the right to some control in therapy. Teaching them a means to indicate refusal and respecting it not only prevents trauma but teaches self-advocacy.

• Champion Alternatives in Policy and Funding: At the macro level, social workers should engage in advocacy to expand insurance coverage and public funding for a wider array of autism services. In many regions, ABA is the only autism intervention covered by insurance or Medicaid, a policy landscape that inadvertently reinforces ABA’s dominance despite the controversies. Social workers, alongside autistic advocates and enlightened professionals, can lobby for insurance mandates to include developmental therapies (e.g., coverage for DIR/Floortime or SCERTS-based programs, which might be delivered by licensed professionals like psychologists or speech therapists), mental health services for autistic individuals (such as anxiety interventions, social groups), and family training programs. Some states have begun pilot programs funding parent coaching in naturalistic developmental approaches – these should be studied and expanded if successful. On a legislative advocacy front, social workers can support efforts to ban cruel practices (for instance, join voices with disability rights groups calling to outlaw electric shock aversives or other abusive techniques that are still legal in certain facilities). We can also advocate for standards and accountability for all autism providers: for example, requiring that any state-funded autism therapy program demonstrate how it ensures client dignity, obtains informed consent, and measures quality of life outcomes. The Autistic Self Advocacy Network (ASAN) and other neurodivergent-led groups often put out policy briefs; social workers should collaborate with and uplift these voices, bringing our organizing and policy expertise to the table.

• Embed Neurodiversity-Affirming Practices in Agencies: Social service agencies and autism service providers that employ social workers can integrate neurodiversity principles into their organizational policies. For instance, agencies can create guidelines that explicitly forbid goals or methods aimed at suppressing harmless autistic behaviors (no training kids to stop flapping or to force eye contact, etc.). They can implement trauma-informed care training for all staff so that signs of distress are recognized and interventions adjusted accordingly. Agencies might also form autistic advisory councils – consulting with autistic adults (including those who may have been former clients) to review programming and materials  . This follows the mantra “Nothing about us without us,” ensuring the services align with the population’s actual needs and values. Social workers in supervisory roles can ensure their teams approach autism support from a stance of acceptance and patience, rather than compliance and control. Additionally, hiring neurodivergent staff (including autistic social workers, therapists, or peer mentors) is a powerful way to shift organizational culture and provide clients with relatable role models. Social workers can advocate for neurodiversity training in graduate programs and continuing education, so that new professionals entering the field are exposed to the lived experiences of autistic individuals and learn about respectful approaches beyond ABA.

• Support Families and Individuals through Transitions: Social workers often work with autistic people beyond early childhood, including during adolescence and adulthood transitions. It’s important to note that the impact of early interventions like ABA may surface later – for example, a teenager might grapple with trauma or identity issues from years of masking. Social workers should provide spaces (support groups, counseling referrals) for autistic teens and adults to process their experiences. In practice, a clinician social worker might help an autistic adolescent unlearn the shame or rigid compliance they internalized, perhaps through strength-based therapy that affirms their neurodivergent identity. At the family level, we can encourage parents to move from a “fixing” mindset to a supportive one as their autistic child grows into an autistic adult. This might involve parent support groups that introduce neurodiversity concepts, connecting families with autistic adult mentors who can share positive narratives, and educating families about the importance of autonomy for their loved one (for instance, supported decision-making instead of guardianship, if applicable). Essentially, social workers can facilitate a paradigm shift within families – from seeing autism as a tragedy requiring intensive correction, to understanding autism as an integral part of the person that can be accommodated and celebrated.

• Policy Advocacy for Systems Change: At the broader societal level, social workers should advocate for policies that embed neurodiversity acceptance in education, healthcare, and community living. This could include pushing for inclusive education policies that don’t hinge on autistic students behaving like non-autistic students to be mainstreamed, or advocating for funding of sensory-friendly community programs. Social workers can also contribute to research and policy papers that critique harmful practices and propose alternatives (as some have begun to do in ethics journals  ). By contributing our practice insights and ethical reasoning, we lend professional weight to the calls for change that autistic advocates have been voicing for years. Finally, supporting legislation aligned with disability rights – such as banning seclusion and restraint in schools, enforcing the ADA in healthcare settings for communication accommodations, and funding independent living services – will improve the context in which autistic people grow up, reducing reliance on any “normalizing” therapy.

Conclusion

ABA’s prominence in autism treatment is a legacy of its early apparent successes and the desires of a neurotypical society to minimize visible disability. However, through the eyes of autistic individuals and the values of social work, we see that an approach focused on compliance and normalization is fraught with ethical pitfalls. The lived experiences of neurodivergent people – including trauma, loss of identity, and mental health struggles associated with masking – compel us to critically reexamine autism interventions. This paper has highlighted how ABA, despite its mainstream acceptance, often clashes with principles of autonomy, dignity, and non-harm. It has also showcased that alternative paths exist: therapies like Floortime and SCERTS that work with the child’s nature, and professional practices like neurodiversity-affirming OT that prioritize accommodating the individual over changing them. These approaches are consonant with social work’s commitment to person-centered, empowering practice and with the neurodiversity movement’s call for acceptance.

Systemic change is needed to move the field of autism support away from any paradigm that treats autistic people as problems to be fixed. This change is already underway – driven largely by autistic self-advocates, but it requires allies in professions like social work to accelerate and solidify it. Social workers have a responsibility to ensure that interventions do not inadvertently become a source of oppression or harm. By advocating for ethical guidelines, promoting client voice and choice, and educating others about neurodiversity, we help shift the goal from “how can we make this autistic person less autistic?” to “how can we support this autistic person’s well-being and rights?”. The role of social workers includes being advocates and brokers of resources: we bridge families to supportive services, we mediate between clients and systems, and we fight for inclusive policies. In the context of autism, this means fighting for services that truly help autistic individuals thrive – services that respect their neurotype, protect against trauma, and foster skills for self-directed lives.

In conclusion, moving toward neurodiversity-affirming practice is not only about replacing ABA with other therapies; it is about a cultural shift in how we view autism and support autistic people. It means listening to autistic voices at every level of decision-making and aligning interventions with what autistic people themselves define as beneficial (communication access, emotional support, autonomy, acceptance). The social work profession, grounded in social justice and the dignity and worth of each person, must be at the forefront of this shift. By applying our ethical lens and holistic perspective, we can help ensure that autism support systems no longer reinforce harmful practices, but instead uphold neurodivergent rights and well-being. The journey to truly supportive, non-coercive autism services is part of a broader pursuit of disability justice – a realm where social workers can and should be key agents of change. Through continued advocacy, education, and partnership with the neurodivergent community, we can replace compliance with compassion and conversion with affirmation, building a future in which every autistic individual is empowered to be their authentic self without fear or barrier.

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