Chown, N., Hughes, E., Leatherland, J. and Davison, S. (2019), "Response to Leaf
Emerald Publishing Limited
Copyright © 2019, Emerald Publishing Limited
Response to Leaf et al.’s critique of Kupferstein’s finding of a possible link between applied behaviour analysis and post-traumatic stress disorder
Dear Professor Chaplin,
Leaf et al. (2018, p. 127) conclude their response to Kupferstein’s article indicating a possible linkage between applied behaviour analysis (ABA) and post-traumatic stress disorder (PTSD) by contending that “service providers, behavior analysts, funding agencies, and parents should carefully and objectively evaluate (Kupferstein’s, 2018) study prior to avoiding making recommendations for ABA-based interventions for individuals diagnosed with ASD based upon the results”.
We agree that all study reports should be evaluated carefully and objectively. In this polarised situation where there are diametrically opposed views on the efficacy of ABA, it is important that both the Kupferstein and Leaf et al. articles be evaluated carefully and objectively. When an evaluation of this nature is undertaken, we believe it is important to note the following:
Kupferstein’s study was undertaken by a single, unfunded independent researcher in her own time. Given the restrictions she will undoubtedly have faced, her work is of a high quality and should not be dismissed despite the methodological weaknesses.
Barrett et al. state that their response to Kupferstein was “funded by the Autism Special Interest Group [of the Association for Behavior Analysis International] […] and an anonymous donor who supports ABA-based interventions for individuals diagnosed with autism”. Clearly, the authors of the response were funded and were thus far better situated than Kupferstein. Perhaps more importantly, these authors were funded by a group associated with the delivery of ABA together with an individual who supports ABA interventions. Leaf et al. stress that conclusions should not be “designed to support a preconceived notion or belief” (p. 123), implying that they believe Kupferstein’s study fails on this count. However, she only hypothesised a link between ABA and PTSD; it is perfectly good research practice to hypothesise. The issue of a preconceived notion or belief could be levelled at Leaf and his colleagues given their conflict of interest.
Although we agree with Leaf et al. that there are methodological issues with the Kupferstein study, her findings appear to us to justify the expression of concern about a possible link between ABA and PTSD. Kupferstein made certain predictions regarding a substantial number of ABA-exposed children meeting PTSD criteria. These predictions seem to us to follow from her findings. Hopefully, other researchers – independent of organisations associated with either ABA or other interventions for autism – will investigate whether Kupferstein’s findings can be replicated on the basis of studies that avoid the methodological issues highlighted by Leaf et al.
Unless and until there is clear scientific evidence against Kupferstein’s preliminary finding of a link between ABA and PTSD, we think she and this finding should be taken seriously.
Kupferstein, H. (2018), “Evidence of increased PTSD symptoms in autistics exposed to applied behaviour analysis”, Advances in Autism, Vol. 4 No. 3, pp. 122-129.
Leaf, J.B., Ross, R.K., Cihon, J.H. and Weiss, M.J. (2018), “Evaluating Kupferstein’s claims of the relationship of behavioral intervention to PTSS for individuals with autism”, Advances in Autism, Vol. 4 No. 1, pp. 19-29, available at: https://doi.org/10.1108/AIA-02-2018-0007