Optimal

Previous (Part A)

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McGuire writes in more depth about the influence of capitalism in producing childhood and children as sites of ‘investment’ in potential futures (McGuire 2016 119-133). This in turn creates pressure for parents to produce optimal futures for their children by embracing interventions aimed at preventing, curing, or at least mitigating, disability (Carey, Block, and Scotch 2019).

In this conception of childhood, neuro-developmental disabilities, like autism, are constructed as an information-commodities. They are both a justification for clinical intervention, and a framework for understanding which interventions should be prescribed. In this process Autistic bodies and experiences are abstracted and objectified. Far from being an economic burden, Autistic people’s lives, and experiences of disability, become the grist that form the basis of an industry (Mallett and Runswick-Cole 2012; McGuire 2016, 126).

Manidoo Makwa Kwe

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I think therapy can be a great thing for kids, even a life-changing thing. What I object to is the attitude that all kids with disabilities need therapy, and they all need it from the start, and they all need as much as they can get.

Garden of My Heart

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Lovaas’s rhetorical construct of “recovery [to normalcy]” has proven to be so powerful and so culturally resonant for nearly 25 years […]

This explicit linking of the rhetorical construct of recovery [to normalcy] with a particular intervention methodology […] functions ideologically […] foregrounding and naturalizing the notion of ‘intervention’ as the only commonsense response

[…] Implicit in the testimony of both Carmen and Maurice is the assumption that one must do something upon coming to understand that one is the parent of an autistic child, one must intervene in some sort of active way, and that this intervention must involve changing or altering the child in some way.

The question considered by the parents above appears not to be whether to intervene, but rather, how to do so.

Alicia A. Broderick

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Next (Part C)

Always

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Being disabled doesn’t erase the need for down time. Being disabled doesn’t erase the need for play, or for connections to other people.

Ruti Regan

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Anyway… some questions… […]

1) How much time does this kid spend with adults who are in “therapy mode?” How does “therapy mode” look different from how these people would typically act?

2) What skills/behaviors are being targeted? How is the child’s behavior pathologized and controlled based solely on their diagnosis?

3) Is this positive reinforcement, or is this bribery? Is this positive support, or is this holding the world hostage until some sort of compliance is achieved?

4) Is the child really “motivated” or are they being subtly coerced?

5) How does the program address abuse and trauma? How do they commit to not perpetuating it?

6) How is this child segregated or othered from neurotypical peers? Are they expected to do things that realistically, neurotypical children don’t have to do? (An random example I often see is autistic students being taught they can never climb up a slide, even though in the real world, children do this all the time)

7) How is disability accommodated, and how aware are the practitioners of autism’s numerous comorbid clusters? Do they know what faceblindness is? How to recognize absent seizures? Will it cross their mind that their client might be “engaging in maladaptive behavior” because they have a migraine or gastrointestinal pain… or will they seek out other antecedents to blame?

8) Does this child *really* need intervention? Or do they just have a diagnosis and someone willing to put up money? I am not just talking about ABA, but speech, OT, etc. I can think of a lot of autistic adults who didn’t have ABA, but hated their speech therapy sessions. And they still stutter.

9) Is punishment used?

10) Most ABA places will want to know what motivates (reinforces and punishes) the student. But… what motivates the practitioner? Remember, these people want your money, and often have Savior Syndrome to boot.

11) What does the kid think?

12) What is the professional culture and hierarchy like? For example… Can newer therapists question superiors? Are people aware of ethical/accountability reporting processes? Do the “good therapists” just ignore the bad ones?

Meredith K Ultra

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It works because it doesn’t assume; it works because it outwardly claims no value system, other than application of scientific learning principles in naturalistic environments.

But like any valueless system of applied study, its values are many.

Melanie Yergeau

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They are not rejected for their difference, but brought closer.

Practitioners trip over themselves to call it a “science of learning.”

Its surveillance isn’t only (hideously) remarkable for its capacity to observe, chart, and narrate individual acts […] at root it espouses ideologies and technologies of normalization.

It is in a fact a science of regulation and social control.

Not a refusal to recognize them, but an insidious desire to acquire knowledge of them.

Christine Skolnik, Melanie Yergeau

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Next (Part B)

Evidence-based

Previous (Part A)

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Therapy is more art than science. Be suspicious of people who claim that their approach is strictly evidence based. […]

Ruti Regan

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I’m finding myself increasingly annoyed by the emphasis on evidence-based practice in the autism world. This is not because I don’t see the value in responsible intervention practices that are consistent with research and theory.

However, I’m not convinced that championing ‘evidence-based practices’ is the most useful way of confronting quackery.

Having a randomized-controlled trial showing that your intervention does what it is supposed to is great, but there are some areas where quantitative evidence runs into limitations.

• There are many outcomes we can measure, but are all of them the right outcomes to measure?
• How good are we at measuring things?
• Some interventions are harder to study than others.
• Even if it is easy to study a given intervention or measure a given outcome, researchers might not be interested in doing so.
• Evidence-based practice is something that typically comes at the group level.
• There seem to be many areas where quantitative evidence alone is insufficient.
• Realistically, we’re not going to ever be able to develop the sort of evidence base for all the things we think work that we would like.

Based on a post by Patrick Dwyer

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Next (Part C)