What's Wrong with Early Intervention?

I was going to comment on a post about early intervention by Joey's Mom, but I decided to write my own post instead because this is a complex topic that could use more in-depth discussion. Joey's Mom wanted to know why some people object to early intervention, which she found helpful for her son; what's wrong with it?

First of all, as Camille mentioned in a comment, it's necessary to define our terms. Many early childhood services have gotten little or no criticism. There seems to be a general consensus that early speech therapy, physical therapy, and occupational therapy are useful services that are well worth the expense. To the extent that there is a controversy, it has to do with behavioral programs—ABA, in particular.

Part of the problem is semantics, as Joey's Mom suggested. The word "intervention" has strong connotations of urgency and negativity. One intervenes to put an end to a dangerous situation. A family might do an intervention with an alcoholic or drug addict, for example, as a last-chance effort to save him or her from a tragic life on the streets. When we talk about early childhood education for our non-autistic children, we don't call it intervention—we just call it teaching.

Some would say that it doesn't matter what we call it, as long as autistic children get services. But it does matter. When alarmist language sends parents into a panic and convinces them that they must fill every waking moment of their child's days with treatments and therapies, or else the child will be hopelessly lost, that puts a tremendous amount of unnecessary stress on every member of the family. It also portrays autistic lives as less meaningful and valid than others.

Of course, ABA is not solely responsible for the mass hysteria surrounding autism, and I don't think anyone contends that it is. Autistic adults object to ABA chiefly because it has a strong emphasis on suppressing autistic behaviors. This criticism is separate and distinct from the semantics issue and from the question of the effectiveness of ABA teaching methods (as to the latter, it hasn't been scientifically established whether or not ABA has any significant advantages over other methods of education).

In an article in Time Magazine last year, a behavioral therapist was quoted as saying that 50 percent of ABA instruction consists of teaching autistic children "behavior to look good." I see at least three serious problems with that. First, the considerable amount of time spent teaching these children to suppress their natural autistic behavioral patterns is time that the children otherwise could have spent learning useful everyday skills, as well as just playing and enjoying a relaxed life with their family (all children, whether autistic or not, need some amount of unstructured downtime to rest and recharge their energy). Second, when young children are forced to behave in ways that they find uncomfortable or distressing, one should question whether the results justify the distress to the child. (On the long-term psychological effects of being forced to hide one's true self, I recommend the essay Let's Pretend on the autistics.org website.) And third, in our diverse multicultural world, do we really want to teach our children that rote conformity to a narrow set of social constraints is essential?

ABA programs often emphasize making eye contact as a major goal. Autistic children tend to avoid eye contact because they find it unpleasant and distracting. A recent article on MSNBC.com describes teaching an autistic child to make eye contact by means of behavioral therapy:


"We used to say it was like it burned his eyes to look at you," said his mother, Tamie Day of Antelope, Calif. "It was like a physically painful thing for him. It wasn't just that he wasn't looking at us; he was purposefully looking away."

...Before he turned 2, Jacob began daily intensive behavior treatment...

He gets 33 hours of weekly home treatment with trained college students, including six hours most days. The tab is $70,000 yearly, paid for by California, one of the few states that pay, through state and federal funds, for early intensive autism treatment.

Jacob's sessions involve lots of repetition, and rewards, including praise and treats, for a job well done. For example, to improve eye contact, teachers bounce him on a favorite giant ball, then stop. If he turns to look at them, he gets praise, maybe a piece of candy, and more bouncing.


Does young Jacob actually feel more comfortable making eye contact as a result of this behavioral program? Yes, to some extent he probably does, in the same way that a person who has a phobia can be desensitized through repeated exposure. But here's a hypothetical scenario along the same lines: If you had a small child who became upset whenever she saw a spider, would you hire a team of behavioral therapists to dangle spiders in front of her face every day and reward her when she looked at them?

Perhaps you're thinking that the two scenarios are not comparable because a fear of spiders is only a minor inconvenience, while eye contact is a matter of proper social functioning. But when you look at social expectations across different cultures, there are other parts of the world (mainly in the Far East) where making eye contact is considered impolite and is carefully avoided. The human brain is not hard-wired to require eye contact as a condition of meaningful social interaction; it's just a cultural preference.

Of course, for a child growing up in Western society, it is useful to learn that there is a cultural preference for eye contact. This does not have to be taught by repeatedly demanding that the child make eye contact in an intensive early childhood behavioral program, however. As the child grows older, the parents can explain it in the same way that they teach the child about other cultural issues. It is a myth that autistic children must first learn to make eye contact before they learn to speak; to the contrary, because eye contact is distracting to autistic children, they may learn speech more effectively if they are allowed to look away and to give their undivided attention to listening.

Bottom line: Early childhood services that help children to acquire useful skills are worthwhile, but parents would be well advised to stay away from expensive and time-consuming programs that focus on "behavior to look good."