The battle over ABA: autism education in limbo

It’s been one of the longest and most bitter fights in special education policy circles, and it still rumbles on. Campaigners for a particular form of education for children with autism, based on applied behavioural analysis (ABA), claim the Department of Education and Skills remains stubbornly biased against ABA despite what they claim is its status as the oldest, most researched and most successful such teaching methodology.

Even after a decade-long campaign of lobbying and legal action by a number of parents, psychologists and other ABA advocates, which included a gruelling, 68-day, €5 million High Court case in 2007 taken by two parents, those involved say that as well as continuing to misunderstand ABA, the Minister for Education has repeatedly failed to issue any cohesive policy document on autism education despite calls from the Children’s Ombudsman and several TDs.

However, talking to a number of professionals, teachers and parents, it seems that attitudes to ABA remain decidedly mixed.

It is estimated, based on international census data and other studies, that one in 100 of us (children and adults) has autism spectrum disorder (ASD). However, a new survey study from the US-based Center for Disease Control and Prevention puts the figure for children at a staggering 1 in 68. There are around 130 special schools catering for children with ASD, but most now attend special classes in mainstream primary and post-primary schools. An ESRI report showed that 60 per cent of the 357 special classes at primary-school level are designated as ASD classes.

Over the years a small but well-organised group of parents of autistic children – citing international studies pointing to the effectiveness of ABA-based early intervention programmes – have sought support for schools or ASD units that use ABA as their sole method rather than the mix of approaches sanctioned by the Department, often referred to as an “eclectic” model.

In the High Court case, Cian and Yvonne Ó Cuanachain were seeking to compel the State to provide 30 hours a week of ABA tuition for their then six-year-old son, Seán. Judge Michael Peart ruled that the DES’s model of provision, which it had outlined to the court as “Model A”, incorporated ABA along with a number of methodologies and was therefore deemed not to be inappropriate for Sean.

Since then, according to Niall Conlon, a behavioural therapist and member of the Division of Behaviour Analysts in the Psychological Society of Ireland (DBAPSI), around 20 ABA schools, that had been funded directly by the DES either through an ABA pilot school scheme or the home tuition grant, have been forced to close down or turn into standard special State schools.

However, nearly seven years after the 2007 High Court case, it has emerged the Model A approach was already judged by the DES to be “outdated” at the time of the ruling, even though it was a key part of its defence in the case.

During a response to parliamentary questions last month from Tommy Broughan TD, Minister Ruairí Quinn admitted Model A became outdated around the period “2006/2007”.

Cian O'Cuanachain told The Irish Times he was not surprised Model A "disappeared" after the court case. He firmly recalls "at the time, our legal team did a complete demolition of Model A and its provenance". But a DES spokeswoman insisted that as the department "subsequently recognised that the model concept was complex and multi-purpose", its use of language around "models" stopped.

Several politicians have commented on what appears to be a strong anti-ABA attitude from within the Department. In 2008, former education minister Mary O’Rourke spoke of a “lingering animosity” towards ABA, while FG TD Simon Harris said in a Dáil debate last year: “It seems that whoever is appointed the Minister for Education and Skills, regardless of party affiliation and what Government he or she is in, he or she goes into the Department and comes out with a different view on ABA.”

So why is the DES so apparently averse to full ABA programmes for some schools, or to giving the option of ABA through home tuition to those parents who want it?

Due to its scientific nature, advocates say teachers and SNAs working with children with autism in any ABA programme must be supervised by qualified behavioural therapists, leading to concerns over its potentially high cost. However, the directors of Achieve ABA in Donaghmede in Dublin, one of the private schools funded by the home tuition scheme but which has since closed, produced a report for the DES in May 2011 showing it could educate a child with autism using full ABA for around 20 per cent less than a child in one of the nearly 130 State-funded special schools.

But there remains some scepticism about implementing ABA as a sole or primary framework for autism education, particularly among teachers.

Geraldine Graydon is a family support co-ordinator for Autism Initiatives. She has worked closely with educators as well as being a parent of a 24-year old son who has autism and she insists ABA isn't an educational tool for autism. However, she supports its use as part of a "toolbox" for teachers, and adds that it doesn't necessarily have to be supervised by behavioural therapists. "No department of education will provide total ABA, because that would be ratifying one particular method."

Advocates concede that ABA won't suit every child, but they say their biggest problem is trying to correct several lingering misconceptions about it. According to Dr Maeve Bracken, assistant professor and course director of the masters programme in ABA at TCD, some parents say they don't want ABA because "they see it as purely one-to-one; there's no socialisation, no working on the integration skills, and that is a misconception".

She says some teachers and SNAs using ABA do a great job but, without qualified behavioural therapists as part of the teaching team, it can easily unravel. “There are lots of people who would be skilled in the interventions, but they probably don’t understand the science behind it, they don’t know what to do when it all goes wrong, and it does invariably go wrong sometimes.”

According to Bracken, a growing number of behavioural therapists are now opting to qualify as teachers because they feel that is the only way they can apply their qualifications in a school setting.

Bracken says she and others have repeatedly tried to speak to the Minister about ABA. “I don’t know if it is something he pretends he doesn’t understand or he just doesn’t want to deal with it, but we’ve tried on several occasions to correct his misperception, but it goes absolutely nowhere.”

However, Graydon believes some pro-ABA campaigners may have damaged their cause and that of autism education generally by being overly aggressive in lobbying the DES. She says a better focus for lobbying efforts would be for better co-ordination between the departments of health and education in meeting the needs of children with autism, including in supporting IEPs (Individual Education Plans), and for a lifelong autism strategy.

It is currently left up to schools to decide the mix of teaching approaches for each individual child but, in its new report for the NCSE, the ESRI revealed a worrying disparity in how mainstream school principals provide for and manage special classes.

The Government is currently awaiting another report from the NCSE, which it tasked with providing "comprehensive" advice on autism education, but this won't be delivered until the spring of next year.

One parent's experience
Gail O'Driscoll, 32, from Cork, is mother to 12-year-old Ciarán, who was diagnosed with severe autism and intellectual disability at age of three and a half.

Shortly afterwards, having successfully applied for the home tuition grant, O’Driscoll hired a tutor who did a mix of therapies with Ciarán, but at the same time also agreed to try a supervised ABA programme involving qualified therapists.

“I was originally against ABA but I said I’d give it a shot. By the end of the year I was converted. It was clear my son was making massive progress on the ABA programme, and none with the other tutor.”

When Ciarán was enrolled at a special preschool that did not do ABA his behaviour worsened, becoming “more aggressive, kicking and biting people”, and then engaging in self-injurious behaviour.

He went to a special school with a similar ethos but the problems continued. She continued to pay for after-school ABA tuition, but “it was losing battle. He was tired at the end of the day and there was no consistency between home and the school”.

In 2011, after matters deteriorated further at the school, O’Driscoll took Ciarán out and hired two tutors supervised by a qualified ABA therapist using the home tuition grant, although not before hiring – and then firing – three primary-school teachers after his biting behaviour returned. One of them, she says, claimed to be trained in ABA but was against it. She says that under his ABA programme he “is making more progress than ever”.

“When I started he was scared of everything. When we went to social groups and activities, we couldn’t stay out long without a meltdown. Now he loves being out and about with others.”

“But this could all end soon as I have to keep proving I’ve been looking for a primary school teacher,” she said.