Can ABA be used for single issues?
June 29, 2021 5:06 AM   Subscribe

I have been in touch with an ABA therapist in my area. Where I live ABA is not popular or normally available but I am aware of it. Normally I’m happy going with the flow with what’s available here but there is one issue that is disrupting our life. Noise. And lots of it. And I have chronic migraine. Could doing some ABA help? I also wear ear plugs, that helps, but it’s hard for my older son when he’s like to concentrate on something for example.

So, this is a serious issue for the whole family. I have two kids who are Non-neurotypical and the little one with particularly challenging sensory issues.... and they both are making noise a lot, hey- they are 5 and 6 year old boys- I get that there is going to be noise. But this is going beyond normal noise. Especially for my little guy. He is making noise all the time, humming, grunting, making up words, fake words that rhyme, “singing” but I can’t tell the difference. THAT will annoy any one of us sometimes and either my older boy tells him to stop and it turns I to a fight (which is loud) or I ask him to stop, which he probably CAN’T... then he gets his feelings hurt and gets upset (which is even louder) OR he’ll start hysterically laughing loudly .

As a person with migraine my life is kind of a nightmare. My kids are otherwise very nice and I love them but having difficult feelings and this is a hard time for me. You can’t imagine the way it feels to hear grinding and humming and fake words etc when you have a migraine, and sometimes it triggers a migraine... and for the last couple years I’d say I was in some part of the migraine cycle every day. This is getting better! Yay! But sound sensitivity remains.

We have a camping trip planned across the continent and a few days ago I literally said to my husband that I wasn’t going to put myself in the car with the pair of boys- so I’m taking the older one for a week and husband will fly out with the little fellow.

We’re hoping a break will help!

Anyway, you get the picture. He’s not diagnosed with anything yet- he’s got issues and been getting therapy and is happy in preschool and has his little friendship group there so we haven’t pushed it. But now that school is coming up we’re going to start the process of getting some more support and professionals involved to make sure he’s in the right school environment. BUT I doubt any of this will address this noise issue specifically (although it may improve) and I have a potential opportunity to work with an ABA therapist in the Fall.

I’ve heard it’s got it’s issues BUT perhaps it could be effective for this?
posted by pairofshades to Education (24 answers total) 1 user marked this as a favorite
Just to clarify, you’re looking at putting the kids in ABA?
posted by lokta at 5:12 AM on June 29, 2021

And for the record let me be the first autistic person to say absolutely please don’t, and I hope you get good advice for your situation.
posted by lokta at 5:13 AM on June 29, 2021 [19 favorites]

Response by poster: Thanks for the answers so far. I don’t know much about it to be honest. I guess I was imagining/hoping that this was a behavior management technique that I could learn myself to encourage less noise, or something like that?

I DO NOT intend to start the kids in an ABA program. I’m happy with the way they do things around here and the kids are happy. I just wondered if there was not some small part of it that could be borrowed and used without upsetting or making the child feel disrespected. Maybe that is very naive, but I don’t know that much about ABA.

Ps- if anyone else knows of any potential solutions to this that are NOT ABA please feel free to share.
posted by pairofshades at 5:20 AM on June 29, 2021

The problem with ABA at all is you’re causing traumatic damage to your kid and that can set them up for abuse and exploitation later in life. Use the money if it’s available to fund respite care so you can get a break for your migraine. Another solution people do when a caregiver has access clash issues with a caregivee is to have two dwellings and caregivers rotate in and out. It’s disruptive and expensive and life-altering.
posted by The Last Sockpuppet at 5:45 AM on June 29, 2021 [11 favorites]

If you chip off a tiny piece of ABA somewhere that is not abusive and damaging, that might exist but it's not ABA or anything you would need an ABA practitioner for.

Please keep working with your non-ABA professionals and do specifically ask them about this issue. They may have other suggestions for ways you can work with your children so that all three of you can get your needs met at least some of the time, other types of professionals to refer you to, etc. Meanwhile, yes, respite care is important and finding ways to mitigate your own noise sensitivities is important. Perhaps sound-muffling headphones would help your older son when he wants to concentrate? (Or not, I know sometimes the same kids with sound overload issues are the ones with sensory issues that make Things Touching Head a no-go, but it might be worth trying out a few kinds of sound-blocking earmuffs to see if there's anything that meets all the needs.)

Your competing access needs are valid and important, this just isn't the path to go down to address them.
posted by Stacey at 6:10 AM on June 29, 2021 [2 favorites]

This sounds like something an occupational therapist might be able to help your family with. They should be taking everyone into account and the home environment and might have some suggestions for exercises that might reduce your child's sensory seeking or redirect the vocalizing into something that doesn't trigger you without harming them the way ABA can/does. They may also have suggestions to help you with the sound and migraine issues.
Some people report that those newer earplugs that tamp down some sound ranges are helpful too, worth a try for the price if those aren't the earplugs you're referring to.
posted by lafemma at 6:21 AM on June 29, 2021 [8 favorites]

Where I live, almost everyone whose work is directly relevant calls themself an ABA therapist, but sometimes it's essentially just for the sake of being an approved provider for insurance coverage of autism services. I therefore first ask all prospective therapists who don't outright disavow ABA (of which there are approximately two, alas), "Are you aware of the concerns many autistic adults have about ABA?" and listen very carefully to their responses. Often I hear a bunch of dismissive gaslighting that tells me they're not actually a safe person to work with. Sometimes though the response is satisfactory (as is the response to my follow-up question of "Your card/website lists ABA as a modality you practice, could you describe what that means to you?"), and I come away feeling like they could plausibly be chipping off those tiny bits that are okay and disregarding the entire underlying principles otherwise. I still watch carefully though.
posted by teremala at 6:37 AM on June 29, 2021 [10 favorites]

Response by poster: Wow. Thank you everyone. I had read a few of the ABA questions on here before I asked this one and there weren’t nearly as many answers from people giving such heavy warnings (at my cursory glance) so maybe it’s becoming more common knowledge than before. I hope I haven’t offended anyone by asking the question. I love my kiddos and this sounds like a potentially horrifying experience that doesn’t need to happen. Answers still welcome or potential solutions but I’m convinced.
posted by pairofshades at 6:52 AM on June 29, 2021 [5 favorites]

You didn't do anything wrong by asking. In fact, you're doing exactly the right thing by asking.

And as you say, awareness has increased a lot — there are a lot more adults now who went through ABA as kids, and they've done a lot to raise awareness among those of us who didn't go through it. But, it's still not universal knowledge by a long shot, and it's understandable that you didn't know.
posted by nebulawindphone at 7:01 AM on June 29, 2021 [15 favorites]

So you've accidentally stepped into a minefield that you probably didn't know existed here:

Many adults experienced ABA "therapies" that were basically straight-up abusive and based on essentially treating a kid as a lab rat until they were "fixed". What you're seeing here is the obvious reaction to that. On the other hand, that approach has been completely disavowed, but there is an argument to be made that it's still based on an approach of "the kid needs to change" that is inherently harmful.

However, I will say that my son did have some ABA therapy as a very young kid, and it was just a nice woman playing some games with him that helped him better understand how to play with other people who weren't like him; it was hardly a traumatizing experience--nothing like what the adults describing went through--and was a small piece in the (arduous process) of smoothing out the very rocky start to school.
posted by Dr.Enormous at 7:05 AM on June 29, 2021 [5 favorites]

Occupational therapist is what you want, the good ones are practical and solution focused. I refused aba therapy for my kid on what I’d read by adults with autism of their experiences.

I also have migraines and omg when she will not stop talking talking talking and I need just ten minutes of quiet, it can be brutal. She’s older now and can take being sent out to play so I can not hear her for a bit but when she was younger, super clingy as well. Headphones were a godsend. I played brown noise (white noise bugs me but brown noise tracks are so soothing) and also sunglasses indoors a lot to block out light also. A pillow over your head can be great - I would lie on the ouch with pillows over my head so I could just breathe and the world was muffled while she was fine being able to crawl around near me. And locking yourself in the bathroom a LOT. Oh and timers worked! She could follow a visual and later numerical timer to give me five then ten then twenty minutes of calm by the time she was 6+ and it helped her learn some patience.
posted by dorothyisunderwood at 7:07 AM on June 29, 2021 [6 favorites]

Do you own noise-cancelling headphones for yourself and/or your son? This assumes, yes, that sensory issues allow wearing stuff over ears. If not, please feel free to disregard this entire comment!

My wife and I have both had great experience with Sony WH1000-XHs (she has the 4s, I have the 3s). Turn on noise cancelling mode, play some music or brown/white noise through the bluetooth connection, and the outside world goes away. They probably saved our marriage when we spent the majority of the pandemic sharing one room as our WFH space (we've since moved to a larger home).

If you need to go one step further, have a look at 3M Peltors (or knockoffs thereof). They're intended for firearms use, but have active noise canceling tech, on top of really solid passive noise canceling (think shop ear-safety headphones). They can reduce range noise to safe levels, so they can probably drown out a kid being a kid in most circumstances. The tradeoff is that the passive noise canceling requires a bit of that "head in a vise" feeling, which may or may not be disqualifying based on comfort.
posted by Alterscape at 7:57 AM on June 29, 2021 [1 favorite]

What you're describing is called vocal stereotypy and is likely a form of stimming (self-stimulatory behavior). He is probably doing it to fill a sensory need. ABA will teach him to suppress this. This will lead to a more stressed out, anxious, and potentially traumatized kid. An occupational therapist is what you want. Some other things to consider:

- Try noise canceling headphones--when I'm using mine, I can't hear my partner talking to me at all. It only works when I have music playing, which might not be something you can do with your migraine, but if gentmusic would be better than the noises he's making, consider it.

- Stereotypy is usually a symptom of dysregulation in some way. This can be either positive or negative--he could be overwhelmed or stressed. He could be amped up from excitement or anticipation. Stereotypy may help him regulate and bring his nervous system down (there's research showing that repetitive behavior directly acts on the nervous system to bring us back into homeostasis). If you can find a non-ABA therapist who specializes in autism (even if your kids don't have it, they'll have experience in this area), you can work with them to determine 1) what activates him, and 2) what calms him down. It will be a balance of reducing the things that activate him and planning time to calm down using other tools (weighted blankets, stim toys, etc.) after he has been activated.

- I haven't seen research on this, but in my experience stereotypy's effect on arousal is U-shaped. When I pace, it initially will bring me down. However, if I don't stop at just the right time, it will swing back around and become activating again. But I can't always stop even if I recognize that it's just making me feel worse. It's possible that the noise goes on for so long because at some point it's become unhelpful but he can't stop. Planning specific time to calm down using a variety of tools (as mentioned above) may reduce the amount of stereotypy. I know my pacing dropped from 2 hours a day to 30 minutes a few times a week once I started doing this for myself.
posted by brook horse at 7:58 AM on June 29, 2021 [13 favorites]

However, I will say that my son did have some ABA therapy as a very young kid, and it was just a nice woman playing some games with him that helped him better understand how to play with other people who weren't like him

As a note, ABA was the only therapy insurance would cover for autism for a long time so a lot of places learned to market themselves as ABA even if what they're doing barely resembles it. So, it's possible you got something that wasn't actually ABA even though it was marketed as that (I know, it's super confusing and shitty for families).

That said, "teaching him how to play with other people who aren't like him" can still be harmful if it requires suppression/masking of his (presumably, if you were getting ABA) autistic ways of interacting with the world, and masking is associated with all sorts of mental health problems. I have a great understanding of how to converse with people who aren't like me. Implementing that is still stressful and unnatural for me and has not ever actually succeeded in helping me make friends with non-autistic people. It has just made me more anxious and aware of the ways that I'm fucking up. I'm not saying it couldn't have been helpful for your son, but that "helping him understand how to interact with non-autistic people" isn't inherently non-problematic.

This assumes, yes, that sensory issues allow wearing stuff over ears.

I avoided noise canceling headphones for a long time for this reason, but it turns out that there's plenty of earbuds with great noise-canceling abilities. I use the Earfun Free Pro, but there are much fancier ones that would probably do an even better job. Do consider earbuds if over-the-ear headphones aren't an option.
posted by brook horse at 8:08 AM on June 29, 2021 [15 favorites]

One super interesting idea our OT mentioned was that, basically, people often seek to have all of their senses (including stuff like the vestibular system and tactile input) "balanced," and achieving that can require seeking out apparent extremes on one axis because the sensitivity on other axes is so high, and/or because the first axis has a higher "activation" level before it's satisfied in the same way as the others. So for a simplified example: if he experiences visual stuff as highly stimulating, but auditory at a more typical level, and he's getting a bunch of visual input (as essentially everyone who can see does, since our brains tend to prioritize it) that he's very sensitive too, then perhaps he needs to really crank up the auditory to match. But another approach would be to try toning down the visual input to what would be low to a neurotypical person, and thus maybe about average for him, and then the auditory would naturally match it more closely without requiring supplementation, or at least less supplementation. (For your purposes, replace "visual" with any other sensory input as needed, obviously.)
posted by teremala at 8:14 AM on June 29, 2021 [5 favorites]

That said, "teaching him how to play with other people who aren't like him" can still be harmful if it requires suppression/masking of his (presumably, if you were getting ABA) autistic ways of interacting with the world, and masking is associated with all sorts of mental health problems

I was trying to tiptoe around having to elucidate this part, but fine: destroying the classroom and punching teachers because he was expected to share toys or take turns, or was just having a high-stress day, was not an acceptable "way of interacting with the world", and ABA therapy (and I am very well educated in this area and not confused at all) was a part of the solution to that. I was being as respectful as possible of people's legitimately-awful experiences, but the fact of the matter is that (more recently) plenty of people have totally innocuous and helpful experiences as well, and that should be considered by the OP too. Hence my term "minefield".

He's in middle school now and perfectly aware that some things are just going to be different and that's fine (like we can explain to him that people think he's not paying attention when he's looking away but that we know he is), he can tell the difference between what matters and what doesn't, and he can communicate about how things are going with him. At 4-5 years old, none of these were possible.
posted by Dr.Enormous at 8:27 AM on June 29, 2021 [17 favorites]

I recognize this is a bit like suggesting you find a unicorn, but I wonder if there are any child therapists in your area who are themselves autistic. I want to be delicate here, and acknowledge that stimming is normal and healthy and also that making noise in a way that hurts someone else by making their migraines more difficult is a problem. Everyone needs to learn social skills in the sense of learning to recognize how their behavior is impacting others, how their communication is or isn't successful, etc. I wouldn't trust an ABA therapist, but I do think there could be benefit to some non-stigmatizing therapy.
posted by theotherdurassister at 9:05 AM on June 29, 2021 [2 favorites]

For the whole fam, perhaps add Loop or Calmer earplugs to your repertoire? They take noise down 15-20 decibels, you can still hear conversations but it reduces overwhelm.
posted by lloquat at 9:11 AM on June 29, 2021 [2 favorites]

You could look into Floortime therapy, which was good for one of my kids and -- unless I've missed something, it's been years -- doesn't have the same horrible reputation as ABA.
posted by The corpse in the library at 12:29 PM on June 29, 2021

destroying the classroom and punching teachers because he was expected to share toys or take turns, or was just having a high-stress day, was not an acceptable "way of interacting with the world"

Aggression isn't an "autistic way of interacting with the world." It's what happens when autistic people are forced to interact with the world in a way that is unnatural and distressing to us. Sharing and turn taking are difficult for autistic people because we struggle with transitions and switching, and we often prefer to focus on one stimulus for a long time. Non-autistic play involves rapid switching between multiple objects and activities with little to no warning. It's overwhelming and makes kids have meltdowns, which can include aggression. The solution should be to find a compromise that doesn't favor the non-autistic mode of play more than the autistic mode of play. Parallel play, games with longer turns, clear signposting before transitions, etc. can all allow autistic kids to engage in play that respects their autistic ways of interacting with the world.

I was a kid with aggressive behavior, including hitting people. Telling people to shut up and throwing things at their heads was not an acceptable behavior. But it only happened because people didn't listen to me or let me do the things I needed to to decrease my distress. If people had respected my needs, or allowed for some compromise, I wouldn't have had a meltdown. It's the expectation that I interact with people on THEIR terms, never mine, that caused those problems. Teaching me to suppress the meltdown while still making me interact in non-autistic ways would have been better for the people around me, but would have made me much more depressed and anxious. I know because I tried to force myself to do this as a young adult, and it did just that. I'm a much happier person now that I've accepted that I process and interact with the world differently and my goal should not be to emulate non-autistic methods of interaction. I'll share and take turns, but only with appropriate preparation, enough time to think and process, and minimal distractions to overwhelm me. My friends know that if they want to borrow something they need to give me time to think about it and adjust to being without the object and that if they ask, "Hey, I want to borrow this for this trip I'm taking this evening," the answer is going to be no. If they give me that time, I'm a very generous person and almost always say yes even if it inconveniences me. But I need the time to adjust and forcing myself to share without that time just makes me anxious and upset.

I don't know what your son's therapist did and I don't want to argue over it. But this is why just "teaching him how to play with other kids" isn't inherently non-harmful. Again, not trying to argue whether it was good for your kid or not. I'm saying this to illustrate to the OP that just because an ABA provider seems nice and doesn't use punishment doesn't mean what they're doing is respectful of autistic people and not harmful.

You could look into Floortime therapy, which was good for one of my kids and -- unless I've missed something, it's been years -- doesn't have the same horrible reputation as ABA.

From what I've seen Floortime is a good model but it is very often combined with ABA, so you need to be careful that your provider isn't doing that. Relationship development intervention (RDI) is another good one. There's also a handful of models that have some really good stuff but then tack on ABA because that's what's considered "legitimate." Early Start Denver Model does this. There's a lot you can take from the first half of An Early Start for Your Child With Autism (an accessible layperson's book) and just ignore the second "ABCs of Teaching" (ABA) half.
posted by brook horse at 1:00 PM on June 29, 2021 [25 favorites]

I sent you a me mail message.
posted by 15L06 at 4:20 PM on June 29, 2021

I have auditory processing issues, and everyone I love has ADHD. And most suspect I'm autistic as it turns out.

The loop/calmer/happy ears earplugs are great - they allow me to spend a lot more time with my family than previously, and I'm less likely to meltdown if I have them. My father can't stand them, they increase his tinnitus, but for me taking out the upper 20% helps.

I taught my kid rudimentary sign, so she uses that sometimes. Now she is literate we also text a lot. She chews a lot of things too; not so much silicon necklaces or whatever sadly, but stuff. Her and my boyfriend often hunt for chewy things in the fridge and pantry, so I've usually got jerky, dried fruit, and weird chewy candy from Japan. And just accept that all my pencils, pens, water bottle lids or straws, random bits of plastic, hair ties, shirts and so on will be chewed (I have to do reminders on headphone cables though, and fingernails).

Music is almost always on at my house when ADHD folks are around - they will usually fill a silence with some kind of stimulation, and music helps smooth the auditory stuff. I've heard podcasts can help but my folk don't like them - I use them for me when I need something to interrupt tinnitus or weird house noises keeping me awake. With music I have a threshold of familiarity that I demand, basically, so my brain doesn't go into overdrive.

A friend of mine has had a lot of success with the Calmer app I think - basically a mindfulness for the pain type thing. I haven't used it but I have used some of the techniques, and being able to recognise the jaw tension or pressure as separate to the migraine has helped me work on those separately.

Mindfulness for the kid too. Mine would get super pissy when I told her she was grunting but she hadn't realised at all. So helping her identify a thing she was doing allowed her to make choices on it as well. And as she got older she could realise the effect it has on others - particularly me and my migraines/auditory processing.

It gets easier.
posted by geek anachronism at 4:55 PM on June 29, 2021 [4 favorites]

These are really obvious suggestions I'm sure you've tried already, but just in case:

Does he make less noise if he is listening to music etc.? He may be able to do that with headphones or at a lower volume than you will find triggering.

Do gum, or frozen pops, or oral sensory toys quiet him down for any length of time?

Have you tried everything possible to reduce the frequency and intensity of your migraines despite the inescapable trigger?

I think that unfortunately the techniques that could be used to encourage him to be quiet are all going to also generate excessive self-consciousness or the sense that he is always annoying, which to kids can mean pretty much the same thing as "bad." So much sympathy for the tough place you're in, and I hope he naturally outgrows this really quickly.
posted by metasarah at 11:47 AM on June 30, 2021 [1 favorite]

It sounds like both you and your son have sensory issues. What you're looking for is an occupational therapist. I can't stress this enough. Get the son in OT stat--they will be able to figure out his specific brand of sensory processing difficulties and teach him more appropriate ways to manage it. I would also wonder if there is a way to get some therapy for yourself, OT or otherwise (but preferably OT, though OT for adults with sensory issues is terribly difficult to come by). There are strategies to calm an overstimulated nervous system and I think they would help you and your kids immensely. Good luck!
posted by Amy93 at 7:54 PM on June 30, 2021 [3 favorites]

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