ABA's Dark History

A working BCBA asked a question in public recently: why does behavior analysis stay off by itself while immunology, genetics, and pharmacology share patients and work together? The poll that went with it offered four answers: ego, billing, no cross training, and not reading the literature.

I went looking for the real answer, and I did not expect to end up where I did. To answer it honestly, you have to go back further than a building code or a training program, all the way to the beginning of the field I am certified in. Then you have to look at the billing codes that run it today, because none of them pays anyone to talk to your child's other providers.

Holding a folder of reports from providers who have never talked to each other? On a 45-minute family care mapping call, we lay out who is on your child's team and what one shared plan could look like. Book a 45-minute family care mapping call

I am a BCBA, but I am not your BCBA. This is general education, not treatment, and not a treatment recommendation for your child or your state. Build the real plan with the people who actually treat your child.

Where it started: Skinner's lab

Everything in this story traces back to B.F. Skinner and operant conditioning: the idea that behavior is shaped by what happens right after it. Out of years of work with pigeons and rats came a genuine, rigorous science of behavior. Skinner published The Behavior of Organisms in 1938, the novel Walden Two in 1948, Verbal Behavior in 1957, and Beyond Freedom and Dignity in 1971. In that last book he argued that human behavior should be engineered at the level of society.

People pushed back hard. Noam Chomsky's takedown of Verbal Behavior is still taught as one of the great intellectual fights of the 20th century. So this is not a modern PR problem for ABA. People were publicly arguing over whether the framework treats human beings like machines to be programmed back when your grandparents were young.

Lovaas and aversives

Ole Ivar Lovaas arrived at UCLA in 1961 looking for nonverbal children for language research, and he found autistic children at the university's Neuropsychiatric Institute. He built an intensive one-to-one method on Skinner's core idea, and some of that work happened at Camarillo State Hospital, an institution.

Punishment entered the method early. By Lovaas's own account, it began when he hit a child to interrupt head banging, and it escalated from there: a floor grid that delivered shock, a remote shock device, and a handheld device that delivered a one-second shock to a child's leg. Lovaas defended this openly, describing isolation and electric shock as "acts of affection" for children who hurt themselves.

That is the founding methodology of a field I am certified in. I am not going to explain it away. Deliberate pain was used as a clinical tool and argued for openly by the most influential early figure in the field.

The 1974 study

In the same era and the same UCLA lab, Lovaas supervised a doctoral student, George Rekers, who ran a different project. It was not about autism. It used the same behavioral principles to try to eliminate what the researchers called feminine behavior in young boys: masculine-coded choices were rewarded, and feminine-coded ones were ignored or punished, including at home through a token system.

The work was published and peer reviewed: Rekers and Lovaas (1974), "Behavioral treatment of deviant sex-role behaviors in a male child," in the Journal of Applied Behavior Analysis. The boy at the center of it was five years old. His family later spoke publicly to CNN about the lasting harm they say it caused, and about his death by suicide as an adult in 2003. Rekers publicly disputed that the therapy caused his death. His sister said she wants people to remember "this was a little boy who deserved protection, respect, and unconditional love."

The field did not all accept this at the time. Donald Baer, one of the authors of the 1968 paper that defined applied behavior analysis, published a criticism of the study in 1977. His argument still holds: an intervention is supposed to benefit the person receiving it, not just satisfy what a parent or society is comfortable with.

The 1987 study and the recovery myth

Your child's ABA program is still built on another Lovaas study. In 1987, the Young Autism Project reported on 19 children who received about 40 hours a week of intensive treatment, compared with a control group. It reported that 47% of the intensively treated children performed normally in first grade with normal IQ scores. Lovaas called them "recovered."

That number got real pushback at the time, including questions about whether the children were representative and the lack of independent confirmation of outcomes. Today you will find ABA marketing that attributes "more than 90% of children showing significant improvement" to this study. The study did not report that. Somewhere between 1987 and now, a disputed 47% got rounded up into something the original research never claimed.

The 2020 editor's note

In 2020, the same journal that published the 1974 study issued an editor's note and expression of concern, citing changes in society since the paper was published. It took 46 years for the field's own journal to say anything on the record.

In 2022, Austin Johnson answered that note in Behavior Analysis in Practice. The journal's position was, in effect, that nobody could have known in 1974 the work was unethical. Johnson pointed to Baer's 1977 critique: if a founder of the field knew then, the field knew then. He called for the study to be retracted. This is not a closed chapter. It is a live argument inside the field's own literature.

Deinstitutionalization and the shift into homes

A bigger current runs underneath all of this. Deinstitutionalization came in two waves, mental illness first and developmental disabilities about 15 years behind. Court cases including Souder v. Brennan (1973) and O'Connor v. Donaldson (1975) restricted how institutions could confine people. A 1977 twin study showing a strong genetic component to autism helped push the field away from the discredited "refrigerator mother" theory.

As institutions emptied, ABA's model fit the moment almost perfectly: systematic, measurable, one-to-one, and deliverable without a hospital building around it. That is a real part of why it became the dominant early intervention approach. It also created a new problem: who regulates what happens in a family's living room?

If you are the one coordinating every provider yourself, you are not imagining how hard it is. We can map it together. Book a 45-minute call

Ethics codes and a separate house

The BACB's first ethics-related document was the Professional Disciplinary Standards in 2001. Researchers who tracked this history count roughly nine ethics-related documents across about 20 years, with the most recent full code for behavior analysts in 2022 and separate codes for RBTs. Over the same window, the field exploded, from roughly 5,000 certificates in 2007 to more than 200,000 by 2023.

The field did grow up. I want you to understand what it grew up from, and to consider whether building a profession entirely on its own, separate from psychology and separate from medicine, was about more than professional pride. Legitimacy and distance can be the same project wearing two different faces.

Insurance mandates

Then came the money. Indiana passed the first state law requiring insurance to cover autism treatment. Before that, insurers denied coverage outright, or declared autistic children uninsurable. Even after mandates passed, families spent years fighting appeals because insurers called treatment experimental or educational. South Carolina followed in 2008, and by 2016 at least 43 more states had some version of an autism insurance mandate. Somebody then had to decide, in writing, exactly what would be paid for.

The billing code that doesn't exist

ABA is billed under a set list of CPT codes: 97151 and 97152 for assessment, 97153 and 97154 for direct treatment, and 97155 through 97158 for protocol modification, family training, and group work. Not one of those codes pays a BCBA to call an occupational therapist, a speech-language pathologist, or your child's pediatrician.

Prior authorization is required separately for the assessment, the treatment plan, and ongoing services. Every one of those authorizations is built around units of direct service to the child, not time spent building a shared plan with anyone else on the team. Many payers also restrict same-day billing across disciplines, which discourages more than one provider from touching a case on the same day.

You can put five different service providers all under one roof, but if they have five different treatment plans, that is not an integration. That is an invoice.

That line comes from someone inside the industry, not an outside critic. The shared roof does not mean a shared plan. A lot of so-called integrated care is just several invoices sharing a parking lot.

The training gap

BCBA coursework totals 270 hours: 45 in ethics, 45 in concepts and principles, 45 in research methods, 95 combined in applied procedures, and 30 discretionary hours chosen by the program. There is no required content area for interdisciplinary collaboration. If it happens, it happens somewhere inside those 30 discretionary hours, about 11% of the program.

A 2026 peer-reviewed review on behavior analysts and occupational therapists says plainly that BCBAs "do not typically receive training on collaboration through their coursework." A 2026 study of a center that tried to fix collaboration on purpose, with real structural investment, found most measures did not improve until year two, and some took three years. This is not something a weekend seminar patches.

Diagnosis handoffs: where families get stuck

It starts before ABA enters the picture. A BCBA cannot diagnose autism. It is outside our scope and our licensure. So families wait first for a diagnostician, then wait again for treatment capacity. Diagnostic services are reimbursed low enough that many clinics will not build out that capacity at all. One industry voice described the system as "fractured among clinical specialties."

A 2018 study by Brewer surveyed 620 parents and collected 385 written narratives. Families described entering "a complex and confusing universe of diagnosis and treatment" with nobody coordinating it for them. Mothers cut back their own work hours to manage it, and single and lower-income mothers absorbed the worst of the financial hit. If you are a parent reading this, you did not need a study to tell you that. You are the one holding the folder.

Flaw or feature, reform or abolition

Two arguments run through this whole episode, and they deserve to be named. First, is ABA's fragmentation from the rest of a child's medical team a flaw or a feature? The field's professional bodies say distinct licensure protects a legitimate profession. Researchers trying to build coordinated care say the same fragmentation is the wall in their way. Both are describing the same structure.

Second, is modern ABA meaningfully different from where it started? Reformers point to the BACB's 2020 ethics code, assent-based and child-led practice, positive reinforcement, and stimming no longer automatically suppressed. Abolitionists, including the Autistic Self Advocacy Network, say the goal of modifying autistic behavior toward looking more neurotypical is the problem no matter how gently it is done. And the Judge Rotenberg Center's use of electric shock devices, documented and publicly reported, is still pointed to as proof that the darkest methods are not fully in the past.

The real answer

None of the four poll answers was big enough. ABA's isolation from the rest of a child's medical team is not a personality flaw in your child's BCBA, your pediatrician, or the OT down the hall. It is the traceable result of a specific history: a founding methodology built on deliberate pain, a documented chapter of the field's own literature that used those methods on a five-year-old, and decades spent building separate credentialing, separate ethics codes, and a billing system with no line item for collaboration. The field has only partly reckoned with where it came from, and it will not fully fix the isolation until it does.

Behind every statistic in this story are real people, including real study participants and a family who chose to speak publicly so their son would be remembered. If that is what stays with you more than any billing code, that is the right thing to take away.

Tell me in the comments: how many different providers does your child see who have never once talked to each other? Put the number in the comments.

Sources

• Rekers and Lovaas (1974), JABA, and the 2020 editor's note and expression of concern
• JABA expression of concern (2020)
• Johnson (2022), The weight of harm, Behavior Analysis in Practice
• CNN (2011), Therapy to change 'feminine' boy created a troubled man, family says
• Lovaas (1987), Behavioral treatment and normal educational and intellectual functioning in young autistic children
• BACB Ethics Code for Behavior Analysts
• CASP ABA Practice Guidelines (2024)
• FDA ban on electrical stimulation devices for self-injurious or aggressive behavior

Ashleigh Dominguez, MS, BCBA, is a Board Certified Behavior Analyst licensed in North Carolina, Georgia, and Iowa. This article is general education based on the episode. It is not clinical advice, not treatment, not legal advice, and not a treatment recommendation for your child or your state. Ashleigh is not your BCBA and has not met your family. Please build your real plan with the providers who know your child.