How ABA Therapy Can Exacerbate the Onset of Alexithymia in Autistic Children
Imagine a world where you struggle to express your feelings, a world where understanding your own emotions feels like trying to catch a shadow.
Now, imagine being a part of a community that faces this challenge daily – autistic individuals.
In this blog post, we delve into a critical aspect of autism: emotional self-awareness, its relationship with a controversial therapy known as Applied Behavior Analysis (ABA) and how it can cause the onset of Alexithymia.
It’s a journey that unveils the hidden struggles, questions the status quo, and explores the impact of ABA on those who are neurodivergent.
Welcome to the intersection of emotions, autism, ABA, and Alexithymia.
Understanding Alexithymia
Autism is a characterized by a range of traits in social interaction, sensitivities, and communication.
It’s important to note that referring to “autistic individuals” rather than “ASD” respects the preferences of the community and highlights the unique strengths and differences of autistic people.
“A defining feature of autism is impairment in interpersonal relating and communication. This includes difficulty communicating with others, processing and integrating information from the environment, establishing and maintaining reciprocal social relationships, taking another person’s perspective, inferring the interests of others, and transitioning to new learning environments.” – Lee A. Wilkinson, Ph.D.
What is Alexithymia?
The Significance of Emotional Self-Awareness
“Research suggests that, far from being a core feature of ASD, emotional processing difficulties instead represent a sub-group with co-occurring alexithymia who may have unique needs, particularly surrounding mental health vulnerability and treatment.” – Kinnaird et al. (2019)
While alexithymia isn’t considered a core feature of autism, it appears to co-occur in a significant portion of autistic individuals.
This connection raises important questions about how emotional self-awareness and alexithymia impact the well-being and mental health of autistic individuals.
In the following sections, we’ll explore how the dynamics of emotional self-awareness, especially in autistic individuals, can be influenced by various factors, including developmental patterns and comorbid mental health conditions.
Emotional Self-Awareness in Autism
As Huggins et al. (2021) aptly emphasize, “Emotional self-awareness is increasingly recognized as an important predictor of socioemotional outcomes, particularly in autism.”
This recognition underscores the pivotal role that emotional self-awareness plays in the lives of autistic individuals and how it can profoundly impact their social and emotional well-being.
So, what is emotional self-awareness, and why is it especially significant for those on the autism spectrum?
Emotional self-awareness refers to the ability to recognize and understand one’s own emotions.
It involves not only identifying specific emotions as they arise but also comprehending their underlying causes and effects.
This self-awareness is akin to having an emotional compass that helps individuals navigate the complex terrain of human interactions and relationships.
For autistic individuals, who often face unique challenges in deciphering and expressing their emotions, emotional self-awareness can be a critical key.
It unlocks doors to improved communication, enhanced self-regulation, and more meaningful social connections.
Imagine emotional self-awareness as the compass that guides a traveler through unfamiliar terrain.
Autistic individuals often find themselves in a world where social and emotional cues may appear perplexing or elusive.
In such situations, this internal compass becomes indispensable. It empowers them to:
1. Recognize Emotions:
Emotional self-awareness enables autistic individuals to identify what they are feeling, whether it’s happiness, sadness, frustration, or anxiety.
This recognition is the first step towards effectively managing their emotional responses.
2. Understand Triggers:
Beyond recognizing emotions, emotional self-awareness delves deeper, helping individuals understand what triggers these emotions.
Autistic individuals can pinpoint the situations, thoughts, or interactions that lead to specific emotional responses.
3. Communicate Effectively:
Armed with this awareness, autistic individuals can communicate their emotions more effectively.
They can express their feelings to others, making it easier for peers, family members, and support networks to understand their needs and experiences.
4. Regulate Emotions:
Emotional self-awareness also plays a vital role in emotional regulation.
It equips individuals with the tools to manage intense emotions, prevent meltdowns, and navigate challenging situations more smoothly.
5. Foster Empathy:
Understanding their own emotions can lead to a heightened sense of empathy.
Autistic individuals who are emotionally self-aware may be better able to grasp the emotions of others, enhancing their ability to connect with friends and family.
In essence, emotional self-awareness is a cornerstone for the emotional and social well-being of autistic individuals.
It equips them with the tools to traverse the often intricate and unpredictable landscape of human emotions and interactions.
These insights will provide a crucial foundation as we examine the potential impact of ABA therapy on emotional self-awareness and the onset of alexithymia in autistic children.
Developmental Patterns and Understanding the Impact of Societal Pressures
The developmental trajectory of emotional self-awareness in autism presents a complex interplay of factors.
As highlighted by Huggins et al. (2021), this pattern exhibits intriguing parallels with other facets of development within the autistic spectrum, such as facial emotion recognition and eye-gaze.
But what does this mean, and why is it significant?
Understanding Developmental Patterns
When we refer to developmental patterns, we are essentially looking at how certain skills, abilities, or challenges evolve over time in autistic individuals.
In the case of emotional self-awareness, these patterns bear resemblance to other aspects of development within the autism spectrum.
The Analogy of Growth
To better grasp the significance of this observation, consider this analogy: Picture the journey of a seed growing into a tree.
At various stages of growth, the tree may face unique challenges, from weathering storms to seeking nourishment from the soil.
Similarly, individuals on the autism spectrum go through various stages of development, each with its own set of challenges and milestones.
Non-Uniform Development
The developmental pattern mentioned in the quote from Huggins et al. (2021)
“While no differences emerged in pre-adolescent children, differences emerged during adolescence and increased with age. This developmental pattern bears a resemblance to other developmental patterns in autism, such as facial emotion recognition (Lozier et al., 2014) and eye-gaze (Black et al., 2017).”
This that emotional self-awareness difficulties in autism do not manifest uniformly across the lifespan.
Instead, they follow a trajectory that aligns with the broader developmental course of autism.
Now, what does this imply?
The Role of Societal Pressures
Societal pressures play a pivotal role in this narrative.
As autistic individuals progress through childhood into adolescence and adulthood, they encounter increasingly complex social expectations and norms.
These societal pressures are akin to the storms and soil that influence the growth of our hypothetical tree.
In childhood, these pressures are less intense, and the focus is often on early intervention, education, and building foundational skills.
During this phase, emotional self-awareness difficulties may not be as prominent because the emphasis is on basic social interactions and skill development.
Adolescence: Storms of Complexity
However, as autistic individuals transition into adolescence, the social landscape becomes more intricate and demanding.
The gap in social skills between autistic children and their neurotypical peers often widens during this period.
This widening gap can intensify the challenges faced by autistic individuals, leading to increased social isolation and potential victimization.
Imagine the societal pressures during adolescence as turbulent storms that the tree must withstand.
These pressures can result in heightened mental health issues, including depression and anxiety, which are commonly observed in autistic individuals during this phase.
The parallel with emotional self-awareness development becomes evident.
Just as the tree’s growth faces unique challenges during storms, autistic individuals experience increased difficulties with emotional self-awareness as they navigate the storms of adolescence.
The heightened emotional challenges brought about by societal pressures can further exacerbate these difficulties.
In essence, the developmental pattern observed in emotional self-awareness aligns with the societal pressures that autistic individuals encounter as they progress through life.
Recognizing this connection underscores the importance of providing appropriate support and interventions, especially during adolescence, to help autistic individuals weather these societal storms and nurture their emotional self-awareness.
How ABA Therapy Operates
Applied Behavior Analysis, often referred to as ABA, is a therapeutic approach rooted in the principles of behaviorism.
Practitioners of ABA view it as a valuable tool for behavior modification, particularly in the context of autism.
In this section, we will provide an overview of ABA based on the perspective of ABA practitioners, highlighting its core principles and how it operates in practice.
However, it’s important to note that ABA is a subject of significant controversy, with concerns about its effectiveness and ethical implications.
In the following section, we will delve into the controversies and criticisms surrounding ABA therapy, addressing the perspectives of critics and advocates alike.
Common ABA Techniques
ABA practitioners employ a wide range of techniques to address various behavioral concerns, ranging from communication deficits to social skills development.
These techniques are designed to bring about behavioral changes and enhance an individual’s “functional” skills.
While the specific strategies employed may vary based on an individual’s needs, some common ABA techniques are frequently used:
- Discrete Trial Training (DTT): DTT is a structured, one-on-one teaching method that breaks down complex skills into smaller, manageable steps. It involves clear instruction, repetition, and reinforcement to promote skill acquisition.
- Positive Reinforcement: Positive reinforcement involves rewarding desired behaviors to increase the likelihood of their recurrence. This might include verbal praise, tokens, or preferred items or activities.
- Prompting: Prompting involves providing cues or assistance to help individuals complete a task or respond to a request. Prompt levels can range from full (physical assistance) to partial (gentle guidance).
- Shaping: Shaping is the process of reinforcing successive approximations of a target behavior. It involves rewarding behaviors that gradually resemble the desired behavior.
- Task Analysis: Task analysis breaks down complex tasks into a series of smaller, manageable steps. This approach facilitates skill development by guiding individuals through each component of the task.
- Functional Communication Training (FCT): FCT aims to teach individuals alternative, more appropriate ways to communicate their needs or wants, reducing challenging behaviors.
The Role of Compliance in ABA
One central tenet of ABA therapy and all behavioral therapy is the emphasis on compliance, where individuals are encouraged to adhere to specific behavioral expectations.
This focus on compliance serves as a foundational element of ABA techniques, as it enables therapists to teach new skills and promote “socially appropriate” behaviors effectively.
While compliance is a fundamental aspect of ABA therapy, it is also one of the areas where controversies and criticisms arise.
Controversial ABA Techniques
Planned Ignoring:
Planned ignoring, a technique used in ABA, involves intentionally withholding attention or reinforcement to discourage undesired behavior.
While proponents argue that this approach can be effective in reducing challenging behaviors, it has faced criticism for its potential negative consequences.
Critics contend that planned ignoring may lead to feelings of neglect or frustration in individuals, particularly children, who may struggle to understand why their actions are being disregarded.
For example, if a child refuses to comply with a demand of a practitioner, the practitioner can used planned ignoring.
The child may begin to tantrum or engage in “target behaviors” and so the practitioner may continue to ignore the child.
This can go on for hours before the child realizes the only way they can get out of the situation is by complying.
The practitioner will consider this a win, while the child is extremely traumatized as they just expressed profound emotion for an extended period of time.
The child may take away that their needs or how they feel doesn’t matter. The only thing that matters is their compliance.
This controversy highlights the delicate balance between behavior modification and the emotional well-being of autistic individuals.
Extinction Burst:
Extinction burst is a temporary increase in the frequency and intensity of the targeted behavior when it initially fails to produce the expected response or reinforcement.
In the context of ABA therapy, this can manifest as a sudden escalation of challenging behaviors when a previously reinforced behavior is no longer rewarded.
This can also manifest during a practitioner using planned ignoring to get the desired behavior.
That is why planned ignoring can go on for hours because the child is using all their might.
Through this lens an exctinction burst can be viewed as the child’s last hope before they fall to learned helplessness and realize they must comply.
Critics argue that extinction burst can be distressing for individuals and may inadvertently reinforce the very behaviors therapists aim to diminish.
Understanding this phenomenon is crucial for assessing the potential emotional impact of ABA interventions.
Medicaid and Task Refusal:
Recent changes in Medicaid have raised concerns regarding the removal of task refusal as an appropriate target behavior under ABA therapy.
Task refusal refers to a situation where an individual, often an autistic child, resists or refuses to engage in a specific activity or task.
This aspect of ABA therapy has been controversial, as some argue that it can lead to undue pressure and stress on individuals to comply with tasks, potentially overlooking their emotional needs and preferences.
BCBAs and Extended Response Latency:
Board Certified Behavior Analysts (BCBAs) may use extended response latency to bypass task refusal and facilitate compliance.
This target behavior is collected when a child refuses to comply to a demand.
This is a duration behavior and so you time how long it takes before the child complies.
The purpose of not allowing task refusal as a target behavior was to avoid the harm that overcompliance can do.
However, BCBAs have done semantics games to still use it as a target behavior.
While proponents argue that this approach can be effective in achieving behavioral goals, it raises questions about the emotional experiences of individuals subjected to extended response latency.
Critics contend that this may inadvertently contribute to emotional distress or frustration.
By elucidating these fundamental aspects of ABA therapy and its reliance on compliance, we can lay the groundwork for a comprehensive exploration of how ABA therapy might impact emotional self-awareness and potentially exacerbate alexithymia in autistic children.
The Concerns About ABA and Alexithymia
ABA and Its Approach
Applied Behavior Analysis (ABA) has long been the therapy used in an attempt to change behaviors of autistic children.
One reason for this is because it is one of the only therapy for autistic individuals that Medicaid will insure.
Rooted in behaviorism, ABA traditionally emphasizes the modification of observable behaviors through reinforcement and punishment.
Proponents argue that ABA has led to significant improvements in the lives of many autistic individuals.
However, most of these testimonials come from the parents of the child or the therapist themselves.
Rarely will you find a positive testimonial from the individual that went through the therapy.
Naturally, concerns have arisen.
Specifically concerns regarding its approach and its potential impact on emotional self-awareness, including the development of alexithymia.
Critiques of ABA
Challenging Conformity and Normalization
Critiques of ABA in the context of autism have amplified in recent years, shedding light on several pressing concerns.
At the core of these concerns lies the emphasis on conformity and normalization.
ABA has strived to mold autistic individuals into appearing and behaving as neurotypical as possible.
This sometimes well-intentioned but contentious objective has faced criticism for a variety of reasons.
First and foremost, this conformity-centered approach often leads to the sidelining of the unique strengths, interests, and needs of autistic individuals.
Rather than celebrating and nurturing these differences, ABA has, at times, operated on a deficit-based model that pathologizes neurodivergence.
This outlook can inadvertently undermine the self-esteem and self-worth of autistic individuals, potentially contributing to emotional difficulties, including alexithymia.
The Suppression of Authenticity
Another poignant critique revolves around the historical emphasis on compliance and conformity within ABA.
Critics argue that the strict focus on making autistic individuals comply with predetermined behavioral norms can result in the suppression of authentic self-expression and self-identity.
This suppression is not just about molding behaviors; it extends to stifling the core identity of autistic individuals.
Imagine a scenario where individuals are constantly guided to suppress their natural responses, substitute stimming behaviors with socially acceptable ones, and mask their true selves to fit in.
In such an environment, the unique emotional experiences and expressions that make each autistic individual distinct may be stifled.
This stifling of authenticity can manifest as difficulties in recognizing and expressing emotions and also mental illness.
When individuals are consistently encouraged to mask their true emotions and instead display behaviors that conform to societal expectations, they may gradually lose touch with their genuine emotional responses.
Consequently, this suppression may inadvertently contribute to the development or exacerbation of alexithymic traits.
ABA’s Focus on External Behaviors
ABA therapy typically concentrates on the modification of external behaviors, such as reducing restrictive and repetitive behaviors (RRBs), improving eye contact, or promoting social interactions.
Critics argue that the emphasis on external behaviors may overshadow the internal emotional experiences of autistic individuals.
The concern here is that by prioritizing outward conformity and behavioral suppression, ABA may inadvertently neglect the development of emotional self-awareness.
If individuals are consistently guided to suppress their natural responses and adapt to predetermined behavioral norms, they may struggle to connect with their own emotions, ultimately contributing to alexithymic traits
The Risk of ABA in Exacerbating Alexithymia
Imagine this intricate puzzle we’ve been assembling together.
It’s a puzzle that reveals the interplay between emotional self-awareness, autism, and ABA therapy.
Each piece represents a facet of this complex narrative, and we’ve placed them with care.
Now, as we put in the final piece, the whole picture comes into focus.
Emotional Self-Awareness as the Keystone
In our puzzle, the cornerstone is emotional self-awareness.
We’ve seen how this ability to recognize, understand, and express emotions is not just crucial but profoundly transformative.
It’s the compass guiding us through the maze of our feelings, helping us connect with others and ourselves.
Developmental Patterns and Parallels
Consider how emotional self-awareness develops in neurodivergent individuals, closely mirroring the patterns we see in facial emotion recognition and eye-gaze.
Like a symphony, their abilities evolve over time, becoming more nuanced with age.
But, here’s where it gets interesting: during adolescence, societal pressures intensify.
The world insists on conformity, and our neurodivergent individuals realize that they must play by the rules of a neurotypical society.
The ABA Pieces: Planned Ignoring, Extinction Burst, and Compliance
Now, let’s introduce the pieces that represent ABA therapy.
Planned ignoring, an intentional withholding of attention, forces them to suppress their true selves.
Extinction burst, a temporary surge in undesired behavior when expected reinforcement vanishes, becomes their battle with conformity.
Extended response latency, a tactic to bypass task refusal, allows BCBAs to make non-conformity into a target behavior that they are allowed to collect data on.
All of this pushes autistic individuals deeper into the mold society has crafted.
The Compliance-Focused Approach
The compliance-focused approach of ABA therapy looms large.
It’s the weight that pushes our neurodivergent individuals to comply, often at the cost of their authentic selves.
It teaches them that conformity is more valuable than their inner emotions, their genuine responses.
A dangerous lesson for anyone, let alone those who experience the world differently.
The Puzzle Takes Shape
Now, as we set the final piece into place, the picture becomes clear.
The compliance-focused ABA therapy forces these children into a mold not meant for them.
It makes them realize that everyone else’s comfort matters more than their own feelings.
It pushes their emotions to the back burner.
And in this crucible of conformity, emotional self-awareness can wither, and alexithymia can take root.
The puzzle is complete, and the picture it paints is not without its shadows.
It’s a mosaic of challenges and complexities.
Yet, by understanding how each piece fits together, we gain insight into the potential risks of ABA therapy in exacerbating alexithymia in autistic children.
It’s a revelation that underscores the importance of reevaluating therapeutic approaches, seeking methods that preserve emotional self-awareness, and nurturing the authenticity of every individual on the autism spectrum.
Conclusion
As we come to the end of this journey, we find ourselves at a crossroads of awareness and choice.
We embarked on this exploration seeking to understand the complex relationship between emotional self-awareness, autism, and ABA therapy.
What we uncovered paints a portrait of challenges and potential risks that deserve our attention and consideration.
A Reflection on Alexithymia
At the heart of our discussion lies alexithymia, a condition that makes it challenging for individuals to recognize and express their emotions.
We’ve seen how it can be particularly prevalent among autistic individuals, affecting their ability to navigate the intricate landscape of feelings.
Alexithymia, while not inherently harmful, can impact social and emotional well-being, making it a concern worthy of our exploration.
The Developmental Journey
Our exploration delved into the developmental journey of emotional self-awareness, which closely parallels facets of facial emotion recognition.
We followed the path as it evolved, noting that adolescence brings societal pressures that insist on conformity.
For autistic individuals, this transition can be especially challenging as they grapple with conforming to a world that often misunderstands and stigmatizes them.
The Puzzle of ABA Therapy
We dissected the pieces of ABA therapy, revealing planned ignoring, extinction burst, and extended response latency as tools that can inadvertently push individuals deeper into the mold of conformity.
ABA’s compliance-focused approach, while sometimes well-intentioned, can, suppress authentic self-expression, further complicating emotional self-awareness.
The Choice We Face
Now, as we stand at this crossroads, we face a choice.
We’ve learned that the compliance-focused approach of ABA therapy can risk exacerbating alexithymia in autistic children.
But we’ve also gained a broader perspective on the intricate relationship between autism, emotional self-awareness, and societal pressures.
We have a responsibility, as a society and as individuals, to nurture the authenticity of every individual on the autism spectrum.
We must recognize that conformity should not come at the expense of their emotional well-being.
Instead, let us seek therapeutic approaches that preserve and empower emotional self-awareness.
A Call for Empathy and Understanding
In closing, this exploration is not a condemnation but a call to action, an invitation to empathize and understand the unique journeys of those on the autism spectrum.
It’s a plea to reevaluate therapeutic approaches, ensuring they foster emotional self-awareness rather than inadvertently stifling it.
The puzzle we’ve assembled is intricate, but within its complexities, we find the potential for profound transformation.
By choosing paths that nurture authenticity and emotional self-awareness, we can offer a brighter, more empathetic future for autistic individuals.
Together, let us embrace the beauty of neurodiversity and the richness it brings to our collective human experience.
