[ABANDONED] Ban On Negative Reinforcement Therapy

[Hulldom]

Good day, all.

Today I've written a GA draft that would officially embrace a cause near and dear to my own heart: ending state promotion of Ivar Lovaas' Applied Behavioral Analysis Therapy (ABA). Especially given Commend Elegarth's notation about Elegarth promoting autism awareness, I thought it was time to actually pursue this idea, a policy aim directly tied to autism. (For the record, I was diagnosed at age 3.)

There is a growing lierature which shows that ABA therapy is at least ineffective ineffective and possibly harmful (consider the last two sections and consider reading, if you can, the section on ABA in In A Different Key by John Donvan and Caren Sucker).

I'm not here for a debate over "well, what are we to do otherwise?"

There are two reasons for this:

• While we look at the possible negative externalities of our policies, we are not necessarily inventing treatment guidelines here. We can condemn and end a policy in member nations without necessarily providing an alternative.
• There's not a consensus on alternatives I'm willing, or want, to push. See my above point on alternatives.

Without further ado, the draft. I'm willing to quibble on some of the specific language, but not the intent.

Ban On Negative Reinforcement Therapy

Category: Moral Decency | Area of Effect: Mild

The World Assembly,

Recognizing that certain methods of engendering skill development are harmful to skill development and retention and cause psychological injury;

Noting that in the interest of ensuring that skills learned are skills retained and to reduce the rates of psychological injury among those employing these certain methods;

1. Defines “negative reinforcement therapy” as any type of interaction with the intent to create a skill between a patient and a therapist wherein physically or socially abusive methods are employed when the patient fails to respond to the therapist’s request;
   
2. Mandates that member states end the state promotion and support of negative reinforcement therapy in all settings;
   
3. Requires that member states offer alternative methods of skill-building therapy in all educational establishments;
   
4. Charges states with the obligation to inform those above the legal age of majority of the harms of negative reinforcement therapy and the alternatives available to them;
   
5. Clarifies that denizens of member states may freely seek negative reinforcement therapy upon reaching the age of majority; and
   
6. Further clarifies that denizens of member states who are not legally capable of making the choice for themselves shall have their legal guardians made incapable of choosing negative reinforcement therapy for them.

[Imperium Anglorum]

I don't think the links you have in your OP entirely show your point?

[Hulldom]

I don't think the links you have in your OP entirely show your point?

I would argue they at least show what I'm trying to show. There are clear negatives to this.

[Desmosthenes and Burke]

I don't think the links you have in your OP entirely show your point?

I would argue they at least show what I'm trying to show. There are clear negatives to this.

Not really. All I took from your literature was that there is a fair consensus from the reputable research that exists (with the caveat that there needs to be more and higher quality research done) that ABA therapy is at least somewhat effective and produces desirable outcomes. I did not take from your literature that its modern practice is in any way connected to your resolution, as it is neither physically nor socially abusive in my understanding of either of those terms.

As for your actual resolution, I do not believe children should be abused in therapy, so no problem, but I do not see a link between what you OOC claimed to be an issue and what you are IC attempting to ban, at least on the basis of what you provided.

Edit: IA expanded on this more below, and my thoughts are functionally equivalent. I have exactly zero experience with ASD therapy and intervention options. My personal knowledge on the subject is limited to knowing that France was still institutionalized psychotherapy on children as late as the 2000s which, I assume, everyone here agrees is both unhelpful and generally barbaric to do to children. My comments, like IA's are limited solely to reading the links provided.

[Imperium Anglorum]

I want to preface that I have no horse in this race. I'm looking only at the claims you made and the links you provided ostensibly to support it.

I don't think the links you have in your OP entirely show your point?

I would argue they at least show what I'm trying to show. There are clear negatives to this.

There is a growing lierature which shows that ABA therapy is at least ineffective ineffective and possibly harmful (consider the last two sections and consider reading, if you can, the section on ABA in In A Different Key by John Donvan and Caren Sucker).

"There". https://www.spectrumnews.org/features/d ... n-therapy/. This doesn't seem to support a claim of ineffectiveness.

Given the diversity of treatments, it’s hard to get a handle on the evidence base of ABA. There is no one study that proves it works. It’s difficult to enroll children with autism in a study to test a new therapy, and especially to enroll them in control groups. Most parents are eager to begin treating their children with the therapy that is the standard of care.

There is a large body of research on ABA, but few studies meet the gold standard of the randomized trial. In fact, the first randomized trial of any version of ABA after Lovaas’ 1987 paper wasn’t published until 2010. It found that toddlers who received ESDM therapy for 20 hours a week over a two-year period made significant gains over those who got the usual care available in the community...

The review concluded that early intensive behavioral and developmental therapies, including the Lovaas model and ESDM, are effective for improving cognitive performance, language skills and adaptive behavior in some children. The results for intensive intervention with ESDM in children under the age of 2 were “preliminary but promising.” There was little evidence to assess other behavioral therapies, the review’s authors wrote, and information was lacking on what factors might influence effectiveness and whether improvements could carry over outside of the treatment setting.

Levy, who served on the review’s expert panel, says although the evidence in favor of ABA is not all of the highest quality, the consensus in the field is that ABA-based therapy works.

“There is a lot of good clinical evidence that it is effective in helping little kids learn new skills and can appropriately intervene with behaviors or characteristics that may interfere with progress,” says Levy. There are also other types of ABA that might be more appropriate for older children who need less support, she says... Broadly speaking, the body of research over the past 30 years supports the use of ABA, agrees Volkmar. “It works especially well with more classically challenged kids,” Volkmar says — those who may not be able to speak or function on their own.

"Growing". https://link.springer.com/article/10.10 ... 21-00201-1. This article seems to be the closest to your claim, but it qualifies its own claim as underlined:

Despite decades of usage as the primary method for this population worldwide, ABA has never been shown to be even slightly efficacious for the nonverbal Autism population.

The article also isn't presenting new results; it's a response to a previous article which the response claims mischaracterised an original article's findings, which were related specifically to the qualified group above (from the article: "This subset of nonverbal children with autism who are classified as intellectually disabled were the subject of the review by Sandoval-Norton and Shkedy").

"Literature". https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639250/. This article goes directly against your claim of ineffectiveness:

Applied behavior analysis (ABA) is considered an effective treatment for individuals with autism spectrum disorder (ASD), and many researchers have further investigated factors associated with treatment outcomes. However, few studies have focused on whether treatment intensity and duration have differential influences on separate skills. The aim of the current study was to investigate how treatment intensity and duration impact learning across different treatment domains, including academic, adaptive, cognitive, executive function, language, motor, play, and social. Separate multiple linear regression analyses were used to evaluate these relationships. Participants included 1468 children with ASD, ages 18 months to 12 years old, M=7.57 years, s.d.=2.37, who were receiving individualized ABA services. The results indicated that treatment intensity and duration were both significant predictors of mastered learning objectives across all eight treatment domains. The academic and language domains showed the strongest response, with effect sizes of 1.68 and 1.85 for treatment intensity and 4.70 and 9.02 for treatment duration, respectively. These findings are consistent with previous research that total dosage of treatment positively influences outcomes.

"Ineffective". https://nepc.colorado.edu/blog/autism-and-behaviorism. This isn't an academic article. It's a blog post.

That said, it cites an academic article: https://psycnet.apa.org/doiLanding?doi= ... bul0000215. But frankly, the blog author overstates his case. The underlying academic article writes "Traditional behavioral intervention approaches show some evidence of effectiveness, but methodological rigor remains a pressing concern for this body of research. There is little evidence to date, however, to support the effectiveness of several other interventions that are geared towards young children with autism, including TEACCH, sensory-based interventions, animal-assisted interventions, and interventions mediated solely through technology". The lack of rigorous research is concerning. It is not, however, actual evidence to support your claim of ineffectiveness.

"Possibly harmful". https://manhattanpsychologygroup.com/can-aba-harmful. I'll note also that this isn't an academic article, so it really shouldn't be considered part of any literature. But the claim of harm made directly in the text isn't what the website claims. I mean, the first two sentences are:

ABA is a safe and proven therapy for removing socially and physically harmful behaviors, including behaviors associated with ASD. ABA relies on evidence-backed principles based on academic study, which are applied based on direct observation by the therapist in a clinical setting... In short, ABA is a safe, highly beneficial therapy.

Edit. Unless you are making the claim that there exist some drawbacks (which is true of almost everything), what you cited doesn't seem to support your claims about what you cited, at least on balance.

[Goobergunchia]

We suggest that clause 1 be amended to clarify that the "between" clause modifies "interaction", not "skill":

Defines “negative reinforcement therapy” as any type of interaction with the intent to create a skill between a patient and a therapist with the intent to create a skill, wherein physically or socially abusive methods are employed when the patient fails to respond to the therapist’s request;

Madeleine Kofelgas
Deputy WA Ambassador
Moderately Liberal Unitary Republic of Goobergunchia

[Bears Armed]

We suggest that clause 1 be amended to clarify that the "between" clause modifies "interaction", not "skill":

Defines “negative reinforcement therapy” as any type of interaction with the intent to create a skill between a patient and a therapist with the intent to create a skill, wherein physically or socially abusive methods are employed when the patient fails to respond to the therapist’s request;

Madeleine Kofelgas
Deputy WA Ambassador
Moderately Liberal Unitary Republic of Goobergunchia

OOC: Agreed. Before I read down to your post I was going to question that clause under the 'Understandable English' rule.

And what does

socially abusive

cover?

[Hulldom]

Actually, after some thought, I think I'm going to shelve this for the time being and try to do something new with it. I think the idea itself has merit, and I want to pursue it, but I want to retool the content of the draft a bit before moving forward. Consider this ABANDONED.