Applied Behaviour Analysis and Augmentative Alternative Communication, A Comparison
A general preamble:
Below is the full text of a college assignment and whilst my position on ABA is that it is unequivocally appalling, it was necessary for the purposes of the assignment to be less personally opinionated than I would have liked to be. Ideally if I had time, I would (and may still) rework and phrase differently to reflect how I really feel. But in the meantime, I will share as is, including the bibliography which contains quite a few useful references as I read extensively for this assignment. Interestingly, this assignment was part of a module where ABA was presented in completely uncritical fashion (and certainly the impression was given of a very pro ABA bias) and this essay was allocated the lowest mark I have received. However, I'm completely unapologetic about acknowledging the voices of autistic people who have spoken loudly on the trauma of ABA. This is not a topic which can be discussed without acknowledging the voices of autistic people.
Introduction:
This report will examine two early interventions, the first being Applied Behaviour Analysis, which is a behavioural approach based on learning and reinforcement, and secondly, augmentative and alternative communication, which is a communication-based interventions. Both of these will be explored within the context of the human rights model of disability as utilised by the United Nations Convention on the Rights of Persons with Disabilities (Lawson and Beckett, 2021).
According to the Preamble of the UNCRPD, sections (n) and (o), the Convention recognises ‘the importance for persons with disabilities of their individual autonomy and independence, including the freedom to make their own choices’ and considers that ‘persons with disabilities should have the opportunity to be actively involved in decision-making processes about policies and programmes, including those directly concerning them’ (United Nations Office of the High Commissioner, no date). These sections, in conjunction with the broad ethos of the Convention will serve as a framework for analysis of the aforementioned interventions.
Interventions - Definitions and Descriptions:
Intervention One: Applied Behavioural Analysis
‘Applied behavior analysis refers to an approach toward treatment that includes an emphasis on antecedents, behaviors, and consequences and how these can be arranged to promote behavior change and a methodological approach toward assessment and evaluation. The interventions rely on principles of operant conditioning’ (Kazdin, 2002).
ABA is typically an early intervention which can begin from 2 years. Although there is no specific age limit, it is mainly targeted at younger children, with intensive programming initially. An individualised approach is recommended, however ABA in general follows key themes as mentioned above and is focused on behaviour. It uses positive reinforcement to encourage behaviour change. The behaviour change aims may include reduction of self-harming activities, or increasing of social and communication skills.
Although science based, there are some concerns re data on effectiveness of ABA as an intervention.
Eckes et al. (2023) refer to low methodological quality and high risk of bias in their meta-analysis of primary studies of ABA. Although they indicate that ‘children who receive comprehensive ABA-based treatments tend to show stronger improvements in intellectual functioning and adaptive behavior than children receiving TAU, minimal or no treatment’, they reflect on inadequacies within the research and suggest that a more consistent methodological approach would be of benefit. They suggest that there is no difference in symptom severity when a comparison is made between children who have undergone ABA, and those who have not. Limited demographic sampling is also discussed, as well as vaguely defined control groups which are ‘prone to contamination’ (Ibid.)
Sandoval-Norton, Shkedy and Shkedy, (2019) refer to further research concerns e.g. ‘nearly all research on ABA efficacy excludes the nonverbal population; yet, this is the population that tends to receive continual ABA services over a longer period of time’. Article 7 of the UNCRPD states that ‘States Parties shall ensure that children with disabilities have the right to express their views freely on all matters affecting them, their views being given due weight in accordance with their age and maturity, on an equal basis with other children, and to be provided with disability and age-appropriate assistance to realize that right.’ The practice of ABA routinely being imposed upon children who lack the capacity to consent seems to be contrary to the above. Equally concerning is the lack of longitudinal studies on the impact of ABA when there is a risk of ensuing learned helplessness and lack of motivation (Sandoval-Norton, Shkedy and Shkedy, 2019). A study by Kupferstein, (2018) shows a heightened risk of PTSD amongst those who were exposed to ABA. Interestingly, this research also indicates levels of caregiver satisfaction despite negative experiences of participants which begs the question of who the ABA therapy is intended to help.
Kurchak, (2020, p.78) in speaking of autistic social interaction says ‘If our solutions only address one aspect of this complex situation, we’re really not doing anything to make autistic lives safer or more fulfilling.’
Intervention Two: Augmentative and Alternative Communication
AAC or Augmentative and Alternative Communication is a broad category of supports which allows for communication other than verbal communication. It includes pictures, signs, low, and high tech devices (National Council for Special Education, 2021).
It is defined by the International Society for Augmentative and Alternative Communication as ‘a set of tools and strategies that an individual uses to solve everyday communicative challenges.’
AAC can be used at any age, and is suitable for children under 3, right across the lifespan. For younger children, it can aid in language development and can also be adapted where mobility is an issue, with the assistance of physical or occupational therapy (American Speech-Language-Hearing Association, 2025).
AAC can help autistic children and adults to have a voice and to express needs and wants. It may also reduce the frustration which can occur when verbal communication isn’t possible. For those individuals who are non-verbal, electronic AAC devices also allow for voice output which facilitates greater expression.
As mentioned, AAC includes many different ways of communication support. Per the Royal College of Speech and Language Therapists, (2024), it can be ‘aided’ or ‘unaided’. Unaided AAC requires no extra physical tools and some examples of unaided AAC are using sign language, Lámh, body gestures or eye movements to indicate needs, or vocalisations. Aided AAC can be simple paper or board tools with pictorial aids. It also includes electronic devices, either those specially intended for AAC or apps/programs which can be added to phones or laptops.
AAC can be an enabler of autonomy and personal expression. However, some categories of AAC, like PECS (Picture Exchange Communication System), which are based on behavioural conditioning, are not neuroaffirming. Some of the reasons for this are the use of physical prompting, the possibility of causing distress and the fact that it is a request-based system which doesn’t incorporate the full range of human communication (Price, 2025).
The quote below encapsulates what should be the principle of communication building between autistic individuals and those they interact with.
‘Effective communication occurs when the intent and meaning of one individual is understood by another person. The form is less important than the successful understanding of the message’ (International Society for Augmentative and Alternative Communication, 2011).
Methodologies which are compliance based reduce autonomy and identity, which does not align with the principles of the UNCRPD. According to the UNCRPD (as previously quoted) ‘children with disabilities have the right to express their views freely on all matters affecting them’. This right is age and capacity contingent but crucially acknowledges that children have the same human rights as adults.
Intervention Comparison:
In comparing the two interventions, and in line with the UNCRPD, purpose of intervention should demonstrate evidence that it improves quality of life, autonomy and self-determination for the autistic individual.
Communication:
In terms of language development ABA can assist children to develop some vocabulary, and to make requests. This may reduce frustration and improve relationships with parents or siblings. However, imitation of speech, and language development, are somewhat different and greater language development would be a preferred outcome.
AAC can improve functional communication and comprehension of language, as well as assisting with social uses of language (Drager, Light and McNaughton, 2010).
Both methods may help to decrease behaviours which are challenging or self-harming.
Quality of life:
Both interventions offer potential to improve quality of life. AAC can increase social communication and help develop speech, which offers further learning opportunities. ABA may teach autistic children to integrate better with peers and thus offers some reduction of social stigma. However, accounts of negative effects of ABA on autistic people should not be discounted and further research is needed in this area.
Autonomy:
AAC can increase autonomy by allowing expression of needs and social interaction whilst respecting communication difference.
ABA is generally not autonomy based although some recent practices may be more adapted to neuroaffirming principles.
General:
The aims of each intervention are somewhat different so a straightforward comparison isn’t entirely possible. ABA is targeted at behaviours in general and AAC is centred more around communication but also has further whole of life benefits. Within models of disability, ABA principles are very much centred in the medical model, with the purpose of correcting autistic behaviours. AAC sits better within the social or human rights models of disability as it is more choice and autonomy based. It should be stressed that both of these interventions should be tailored to individual needs and may often be used in conjunction with other supports. They may also need additional training or input from parents and education providers. Both interventions have a wide range of applications and each represent a broad category of tools and methods. ABA has many offshoots, e.g. Positive Behaviour Support, Early Start Denver Model (ESDM) and PECS come under the umbrella of ABA.
Conclusion:
In speaking of supports for autistic people, we need to question firstly, whether those supports are of value and secondly, whether or not they tangibly offer a better quality of life for the autistic person.
Ne’eman, (2021) outlines this idea: ‘When a behavior is intrinsically harmful, such as self-injury, it is appropriate to seek to address it. But many targeted autistic traits do not meet the high standard of intrinsic harm. Lack of eye contact, unusual prosody and the hand-flapping, rocking, and other stereotypies colloquially referred to as “stimming,” among many other autistic traits targeted for intervention, usually pose no problem other than social stigma.’
Interventions where the ‘form’ of communication, and the behavioural norms, are defined solely by those who are not autistic, do not allow for free autistic expression, or for communication and motivational differences between autistic and non-autistic people.
Supports should be centred around what the autistic child or adult needs, and in order to establish evidence for such supports, much greater integration of input from autistic people is necessary within research and practice. This, again, is a core principle of the UNCRPD which states that disabled people should have input into decision making processes which directly concern them.
With regard to ABA, the ‘
Autistic not Weird’ survey of 2022 (Bonnello, 2022) which comprised of responses from 11,212 people, 7,491 of whom were autistic, indicates clearly that ABA is not widely supported.
Similarly, there is a high proportion of those who strongly disagree and who have personally experienced ABA.
Research by (Donaldson, corbin and McCoy, 2021) reflects the experiences of adult AAC users and the negative impacts of forced speech. In contrast, the autonomy and freedom that AAC offers is highlighted when they discuss ‘the “success” that speaking autistic adults who use AAC experience when their communication choices are respected. This theme appears to be influenced by several factors, including communication autonomy and trusted community.’
Fiacre Ryan in ‘Wired Our Own Way’ (Garvey, 2025, p.70) describes what AAC meant to him at the start of his using it:
‘When I was first introduced to spelling on an alphabet letter-board, I was a downy bird trying to fly, weak, scared, worried, daunted, yet marvelling that I finally knew these ABC letters could set me soaring skywards on worded wings.’
The fundamental rights of disabled people are not being met if therapies are intent on diminishing difference simply for the sake of assimilation. Greater societal awareness and education are necessary and a research-based focus on establishing which therapies (according to disabled people) offer support and an increased quality of life.
‘When the suppression of diagnostic traits is seen as an appropriate outcome, people with disabilities are done a grave disservice. Suppressing atypical behavior might not bring increased quality of life—and in some cases might actively reduce it. Although this critique is most developed in autism, it has relevance to many other diagnoses. Further work is needed to integrate neurodiversity into service provision and research.’ (Ne’eman, 2021).
Bibliography:
Ackley, M. et al. (2019) ‘A Review of Language Development Protocols for Individuals with Autism’, J Behav Educ, 28(3), pp. 362–388. doi: 10.1007/s10864-019-09327-8.
American Speech-Language-Hearing Association (2025) Augmentative And Alternative Communication (AAC). Available at: https://www.asha.org/public/speech/disorders/aac/? (Accessed: 16 March 2025).
Anderson, L. K. (2023) ‘Autistic experiences of applied behavior analysis’, Autism, 27(3), pp. 737–750. doi: 10.1177/13623613221118216.
Bonnello, C. (2022) Results and Analysis of the Autistic Not Weird 2022 Autism Survey - Autistic Not Weird. Available at: https://autisticnotweird.com/autismsurvey/#aba (Accessed: 17 March 2025).
Degener, T. (2017) ‘A New Human Rights Model of Disability’, in Della Fina, V., Cera, R., and Palmisano, G. (eds) The United Nations Convention on the Rights of Persons with Disabilities. Springer, pp. 41–59. Available at: https://doi.org/10.1007/978-3-319-43790-3_2 (Accessed: 2 March 2025).
Donaldson, A. L., corbin, endever* and McCoy, J. (2021) ‘“Everyone Deserves AAC”: Preliminary Study of the Experiences of Speaking Autistic Adults Who Use Augmentative and Alternative Communication’, Perspect ASHA SIGs, 6(2), pp. 315–326. doi: 10.1044/2021_persp-20-00220.
Drager, K., Light, J. and McNaughton, D. (2010) ‘Effects of AAC interventions on communication and language for young children with complex communication needs’, 3(4), pp. 303–310. doi: 10.3233/prm-2010-0141.
Eckes, T. et al. (2023) ‘Comprehensive ABA-based interventions in the treatment of children with autism spectrum disorder – a meta-analysis’, BMC Psychiatry, 23(1). doi: 10.1186/s12888-022-04412-1.
Frolli, A. et al. (2022) ‘AAC and Autism: Manual Signs and Pecs, a Comparison’, Behavioral Sciences, 12(10), p. 359. doi: 10.3390/bs12100359.
Garvey, N. (ed.) (2025) Wired our Own Way: An Anthology of Irish Autistic Voices, p. 70.
van Grunsven, J. and Roeser, S. (2022) ‘AAC Technology, Autism, and the Empathic Turn’, Social Epistemology, 36(1), pp. 95–110. doi: 10.1080/02691728.2021.1897189.
Iacono, T., Trembath, D. and Erickson, S. (2016) ‘The role of augmentative and alternative communication for children with autism: current status and future trends’, NDT, Volume 12, pp. 2349–2361. doi: 10.2147/ndt.s95967.
International Society for Augmentative and Alternative Communication (2011) ISAAC – About AAC, International Society for Augmentative and Alternative Communication. Available at: https://isaac-online.org/english/about-aac/ (Accessed: 15 March 2025).
Kazdin, A. E. (2002) ‘Applied Behavior Analysis’, in Hersen, M. and Sledge, W. (eds) Encyclopedia of psychotherapy. Amsterdam: Academic Press, pp. 71–94. Available at: https://doi.org/10.1016/B0-12-343010-0/00010-6. (Accessed: 2 March 2025).
Kupferstein, H. (2018) ‘Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis’, AIA, 4(1), pp. 19–29. doi: 10.1108/aia-08-2017-0016.
Kurchak, S. (2020) I Overcame My Autism and All I Got Was This Lousy Anxiety Disorder. Douglas & McIntyre, p. 78.
Lawson, A. and Beckett, A. E. (2021) ‘The social and human rights models of disability: towards a complementarity thesis’, The International Journal of Human Rights, 25(2), pp. 348–379. doi: 10.1080/13642987.2020.1783533.
Light, J. and McNaughton, D. (2012) ‘The Changing Face of Augmentative and Alternative Communication: Past, Present, and Future Challenges’, Augmentative and Alternative Communication, 28(4), pp. 197–204. doi: 10.3109/07434618.2012.737024.
Logan, K., Iacono, T. and Trembath, D. (2017) ‘A systematic review of research into aided AAC to increase social-communication functions in children with autism spectrum disorder’, Augmentative and Alternative Communication, 33(1), pp. 51–64. doi: 10.1080/07434618.2016.1267795.
Lovaas, O. I. (1987) ‘Behavioral treatment and normal educational and intellectual functioning in young autistic children.’, Journal of Consulting and Clinical Psychology, 55(1), pp. 3–9. doi: 10.1037//0022-006x.55.1.3.
National Council for Special Education (2021) Autism and Augmentative Alternative Communication: A resource for parents and teachers to support the Post Primary level and Primary level Summer Programme, National Council for Special Education . Available at: https://ncse.ie/wp-content/uploads/2021/06/Autism-and-Augmentative-Alternative-Communication.pdf (Accessed: 13 March 2025).
Ne’eman, A. (2021) ‘When Disability Is Defined by Behavior, Outcome Measures Should Not Promote “Passing”’, 23(7), pp. E569-575. doi: 10.1001/amajethics.2021.569.
Price, E. (2025) PECS & ABA | AutisticSLT, AutisticSLT. Available at: https://www.autisticslt.com/pecs-aba (Accessed: 16 March 2025).
Psychology Today (2022) Applied Behavior Analysis, Psychology Today. Available at: https://www.psychologytoday.com/ie/therapy-types/applied-behavior-analysis (Accessed: 3 March 2025).
Royal College of Speech and Language Therapists (2024) Augmentative And Alternative Communication | RCSLT, RCSLT. Available at: https://www.rcslt.org/speech-and-language-therapy/clinical-information/augmentative-and-alternative-communication/#section-3 (Accessed: 15 March 2025).
Sandoval-Norton, A. H., Shkedy, G. and Shkedy, D. (2019) ‘How much compliance is too much compliance: Is long-term ABA therapy abuse?’, Cogent Psychology, 6(1). doi: 10.1080/23311908.2019.1641258.
United Nations Department of Economic and Social Affairs (no date a) Guiding Principles Of The Convention | Division For Inclusive Social Development (DISD), United Nations. Available at: https://social.desa.un.org/issues/disability/crpd/guiding-principles-of-the-convention (Accessed: 8 March 2025).
United Nations Department of Economic and Social Affairs (no date b) Introducing the United Nations Convention on the Rights of Persons with Disabilities. Available at: https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2022/01/Introducing-CRPD-English-.pdf (Accessed: 2 March 2025).
United Nations Office of the High Commissioner (no date) Convention on the Rights of Persons with Disabilities: Preamble. Available at: https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities (Accessed: 2 March 2025).
