The Side of ABA Therapy No One Talks About

Applied Behavior Analysis (ABA) is widely recognized as one of the most common therapeutic approaches for autistic children. Some families report gains—particularly in communication or daily-living skills.

Yet autistic self-advocates and some clinicians have raised important concerns, from emotional safety to the risk of teaching kids to mask who they are. This post looks at both sides so you can make an informed, child-centered choice.

What Is ABA Therapy?

ABA therapy is a structured approach to teaching new skills and reducing behaviors that may signal overwhelm or unmet needs in individuals with autism spectrum disorder. Based on behavior analytic principles, it uses techniques like positive reinforcement to increase adult-defined target behaviors and reduce actions seen as ‘challenging’—even when those actions are a trauma or sensory response. ABA procedures can be implemented across various environments, from therapy sessions to school and home settings.

ABA therapy is widely supported by some large institutions, including the U.S. Surgeon General.

In practice, it often targets behaviors like speaking over Augmentative and Alternative Communication (AAC) use, eye contact, or sitting still—skills that are usually chosen by adults rather than by the child. ABA programs vary widely, from short, play-based sessions to intensive 40-hour-per-week schedules that resemble full-time jobs for a preschooler.

Although widely marketed as ‘evidence-based,’ research on long-term well-being and mental health outcomes is limited and mixed.

Concerns and Criticisms of ABA Therapy

One major concern with some ABA programs is that they use standardized procedures without fully adapting to the unique needs, preferences, or sensory experiences of the child. When therapy isn’t individualized, sessions can become frustrating or overwhelming instead of supportive.

For example, if your child has sensory sensitivities, a rigid program might overlook those needs—causing stress rather than building skills.

When “Skill-Building” Really Means Compliance

Some critics, including many autistic self-advocates, have raised concerns that certain ABA approaches prioritize making children appear neurotypical—rather than supporting how they naturally think, feel, and connect.

For instance, stimming (like hand-flapping, rocking, or repeating sounds) is often a self-soothing behavior. Teaching a child to suppress it for the sake of “looking typical” may ignore its purpose and create confusion or distress. Repeatedly teaching a child to hide natural autistic traits—called masking—has been linked to increased anxiety, burnout, and depression in autistic adults. Skill-building should always honor a child’s inner experience—not just focus on how they appear to others. 

Potential Emotional Toll of Intensive Schedules

ABA is sometimes delivered in very high doses—20 to 40 hours a week, even for toddlers. Some autistic adults have shared that these intensive programs felt emotionally exhausting or even traumatic, especially when their feelings or resistance were overlooked.

When therapy emphasizes compliance over connection, there’s a risk that a child’s boundaries won’t be honored, and their emotional well-being may be unintentionally harmed.

Ethical Concerns and Historical Practices

ABA’s history includes the use of “aversives” (punishments or discomfort) to stop unwanted behaviors. While many providers have moved away from these techniques, the legacy still shapes how some autistic people and families view ABA today.

It’s essential to ensure that any therapy approach is based on respect, empathy, and safety—not control.

What to Know About Ethical and Individualized ABA

Before any intervention is chosen, the most important step is asking: “What matters to this child? What skills feel meaningful to them right now?” Ethical practice begins with honoring autonomy and seeing behavior as communication—not a problem to fix.

While some providers are working to create more ethical and child-centered versions of ABA, these approaches are still the exception—not the norm, and may be hard to find in many regions.

It’s also worth knowing that ABA is often the default recommendation because it’s the most widely covered autism therapy by insurance providers—not necessarily because it’s the best fit for every child. This can leave families feeling like ABA is the only option, even if their gut says otherwise. If you’re in that position, you’re not alone—and there are still ways to advocate for care that honors your child’s needs and values.

If you are exploring ABA, ask thoughtful questions to ensure the provider truly centers your child’s autonomy, emotional safety, and sensory needs. The most respectful and responsive ABA therapists take a collaborative approach, working closely with parents and caregivers to create individualized treatment plans. These plans honor the child’s strengths, preferences, and challenges—rather than applying a one-size-fits-all model.

Some modern ABA providers are working to shift the focus away from “fixing behaviors” and toward building meaningful, everyday skills in a more respectful and child-centered way.

When done thoughtfully, this might include:

• Facilitating communication in ways that feel natural to your child—whether through spoken words, gestures, AAC (like a tablet or picture cards), or a mix

• Fostering social connections that feel good to them, without pressure to act or interact in neurotypical ways

• Teaching life skills like brushing teeth, getting dressed, or asking for help—always at a pace that feels safe and manageable

The most important thing is that these goals come from your child’s needs and interests—not just a checklist of what’s “expected.”

Shifting Toward Compassionate Practices

Ethical ABA-based intervention goes beyond achieving desired behaviors. It’s about making sure the child feels safe, supported, and understood. Incorporating feedback from autistic self-advocates—as well as the autism community at large—can help shape more compassionate and effective practices.

Many board-certified behavior analysts are now exploring trauma-informed ABA approaches that emphasize empathy, emotional safety, and respect for a child’s boundaries.

Exploring Alternative and Complementary Therapies

ABA is not the only evidence-based option available to support autistic children. Depending on your child’s needs, interests, and learning style, other therapies may offer more flexibility, connection, or sensory support. These approaches can be used alongside ABA—or on their own—and include both structured therapies (like OT or speech) and more relationship-based models like play therapy and Floortime.

Here are a few options to consider:

• Speech Therapy: Supports communication in ways that feel natural and effective for your child—whether that’s spoken language, gestures, or AAC (Augmentative and Alternative Communication) devices. It also helps with understanding and using language in everyday situations.

• Occupational Therapy (OT): Focuses on building essential life skills like dressing, feeding, and handwriting. OT also helps children understand and regulate their sensory needs, making day-to-day life feel more manageable.

• Social Skills Groups: Offers guided, supportive spaces for kids to practice skills like turn-taking, conversation, and navigating peer interactions. When facilitated well, these groups focus on connection—not conformity.

• Play Therapy: A developmentally appropriate, often child-led approach that helps children express thoughts and emotions through play—especially when they don’t yet have the words. Neuro-affirming play therapy supports regulation, builds self-awareness, and strengthens relationships without focusing on behavior correction.

• DIR/Floortime Therapy: A relationship-based model where caregivers and therapists follow the child’s lead during play. It promotes emotional development, communication, and meaningful connection while meeting the child at their unique developmental level.

Note: You may come across other therapies, like Pivotal Response Training (PRT), that are described as more naturalistic or “kinder” forms of ABA. While these models can seem more flexible, they still come from a behaviorist framework. If you're considering options like PRT, it's important to ask the same questions about autonomy, consent, and emotional safety that you would for any therapy.

These therapies can be combined to create a support plan that helps your child grow in a way that feels safe, joyful, and true to who they are.

A Gentle Reminder About Balance

More therapy isn’t always better. It can be tempting to try everything at once—especially when you want to help your child as much as possible. But kids also need time to rest, play freely, and just be. If therapy ever feels exhausting, confusing, or overwhelming to your child, it may be a sign to slow down and simplify.

The right mix and pace of therapy should also fit your family’s bandwidth, so everyone can thrive.

Questions to Ask Any Provider

Choosing the right support can feel overwhelming—especially when therapy programs vary so widely in quality, values, and approach. Whether you're exploring ABA or something else, here are a few questions you can ask to help you find a provider who honors your child’s neurodivergence, autonomy, and emotional well-being:

• How do you involve the child in setting goals?

• What happens if the child says no?

• How do you support emotional regulation—not just behavior change?

• Are all forms of communication equally supported—including AAC or gestures?

• Can you describe what neurodiversity-affirming practice looks like in your sessions?

Building Better Therapy for Individuals with Autism

ABA has helped some autistic children build skills and confidence—but it’s not the right fit for every child, and it’s important to look at the full picture. That includes listening to autistic voices, considering the emotional impact of therapy, and choosing approaches that feel safe and respectful.

No single therapy is a magic solution. The most helpful plans are built around your child’s unique strengths, challenges, communication style, and sensory needs. That might include ABA, or it might involve other therapies like OT, speech, or Floortime.

The key is creating a plan that supports your child’s development while honoring who they already are—not asking them to mask, suppress, or conform.

If you’re considering ABA or any other therapy, ask whether your child’s interests, communication style, and sensory needs will be respected—not overridden.

Unfortunately, not all programs are built with these values in mind, and many families have to advocate for care that honors their child’s neurodivergence. You’re not alone in that journey.

The Importance of Individualized Support Plans

At the end of the day, every child deserves treatment that honors who they are and supports their development on their terms. 

Whether you choose ABA, a play-based model, or a blend, we’re here to help you sort through the options and advocate for care that truly supports your child’s nervous system and sense of self. To learn more about creating an individualized treatment plan for your child, we welcome you to schedule an intro call with one of our specialists at Child Therapy Center LA.

Together, we can help your child thrive.

Schedule Your Intro Call Today