When Therapy Becomes Abusive

"The measure of an individual
can be difficult to discern by actions alone."

~Thane Krios, Mass Effect 2

Autism and therapy tend to go together, especially for autistic children. There are therapies designed to help autistics improve motor skills, work on speech, and fine-tune their social interactions. One commonly-recommended therapy is ABA (Applied Behavioral Analysis). It's also one of the most controversial. Some parents claim their child made huge strides with ABA, but meanwhile, at least one child out there has developed PTSD from it.

All therapies - including ABA - can be beneficial, but they also carry the potential to be harmful or even abusive. I wanted to talk about the warning signs that may signal the therapy is doing more harm than good, whether in the short term or the long term.

(Note: I do refer mainly to the autistic person as a child in this post, because there are very few - if any - therapies designed for teenagers or adults at the time of this writing. If your situation is different, please mentally edit in the appropriate word in place of "child.")

• Red flag: Regular protesting or agitation when it's time to go to therapy.

I know, everyone has bad days sometimes. Chances are you don't get excited about going to work every single day, but if every time you have to go to work, you're in an awful mood and dreading it, chances are something's wrong. Similarly, if a child gets upset every time they have to go to therapy, it's time to sit down and ask very careful questions about what's wrong. If they can't or won't explain, sitting in on a therapy session might be a good idea. Any therapist who refuses to let you observe a session (key word observe - not interfering with the therapy) is another huge warning sign.

• Red flag: Therapy is extremely intensive and/or doesn't allow for breaks.

This is more important the younger the autistic person is. I've heard horror stories of three-year-olds recommended for forty hours a week of therapy - that's as much as a full-time job. With eight hours of therapy added to the recommended twelve hours of sleep, plus time for meals, transportation, hygiene, and so on, now that child has five days out of the week jam-packed, every single week. No time to see friends, no time to play at home, no time just to relax. That's not healthy for anyone, especially not a preschooler.

Long therapy sessions should either have time set aside for a break here and there (again, more frequently the younger the person is), or at least allow it if the autistic person asks for a break. Therapy is designed to stretch a person outside of their comfort level. Doing that for any length of time can be exhausting.

• Red flag: The child's personal boundaries are violated, and/or they are not allowed to say no.

As sickening as it is, there are predators out there who prey on the autistic. In fact, disabled kids are almost three times more likely to experience sexual abuse than those who aren't disabled. It's important for all children to know that their bodies deserve respect, but this is especially true for those with autism.

Because a common trait of autism is not liking touch (either in general or just certain touches), there are therapists who will try and work on this. Forcing or trying to persuade a child to hug or kiss anyone, even family, or touching them in any way without permission can open them up to risk of abuse in the future. People of all ages need to know and understand that their body belongs to them, and that they can and should object if anyone tries to harm them.

• Red flag: Some or all of the therapy goals focus solely on making the person act "normal" or "like everyone else."

You can't remove autism from a person, or "cure" them, or anything of the sort. You just can't. Throughout my life, people have tried to teach me appropriate eye contact, the right way to make small talk, and not to flinch away or start stimming from discomfort at the texture of styrofoam. None of this hurts anyone, so why did they want to train it out of me? My best guess is that they just wanted me to seem more "normal." All the years of making me feel stupid and self-conscious, and it brought next to no progress. Autism is always going to be there.

• Abuse: Food or other basic necessities are withheld at any time, even briefly.

No child should ever be told they can't use the bathroom until they ask "properly" (verbally instead of nonverbally, or with better pronunciation, or asking without flapping their hands, etc). Similarly, food shouldn't be denied because the autistic person isn't doing exactly what the therapist wants.

• Abuse: Nonverbal, or imperfect verbal, communication is ignored.

It's a story I've heard more than once: a child with severe speech delays is sent to therapy to improve their communication skills, and the therapist ignores everything but perfect speech. He wants a drink of water and points to the water jug (or signs water, or says, "Wawa," etc), but it isn't given to him. At best, he's ignored completely; at worst, his attempts to communicate are mocked or belittled while he's left to dehydrate.

(Assuming improved verbal communication is a goal in this situation, a good therapist will take the chance to gently work on asking for water, let the child try a few times, and then give him some regardless of whether or not he made progress.)

• Abuse: The person is not allowed to stim at all.

This one has a two-part answer. Yes, there are stims out there that need to be dealt with, but they're either harmful (head-banging, biting, hitting, etc) or destructive (peeling paint off the wall, spitting on things, and so forth). Working on these kind of stims is not abusive. However, eliminating them is often much harder than redirecting. A child can be taught that hitting people isn't okay, but she's allowed to hit a pillow, for example.

What's abusive is not allowing any kind of stimming, even those that are harmless (hand-flapping, rocking, standing on tiptoe, etc). For autistics, stimming is very helpful and sometimes even essential for regulating our emotions and preventing meltdowns. To add to that, trying not to stim is like trying not to scratch an itch: it consumes more and more of your energy until you're slowly going out of your mind trying not to do it. There is nothing wrong with harmless stimming. Period.

• Abuse: You'd consider it abuse if it was being done to a neurotypical child.

Plain and simple. They may call it therapy, but if anything is being done to your child that you consider unacceptable, it's time to listen to your instincts.

After that list, it might sound like therapy is just a list of negatives, but there are absolutely good therapies out there as well. Assuming a therapy doesn't include any of the above points, it's generally a positive experience for all if:

• The therapist is engaged with their clients, and seems to genuinely like their job.
• The autistic person feels happy and respected.
• You're given, but not pressured into, ways to continue working towards the goals outside of therapy.
• Everyone gets along.
• The autistic person is treated like a person, not a problem to be fixed.

Therapy can help a lot. The important part is making sure everything is in place for that to happen.