Efficacy of Interventions Based on Applied Behavior Analysis for Autism Spectrum Disorder: A Meta-Analysis
Autistic adults in the Netherlands report lower satisfaction with ABA than parents/professionals, citing trauma concerns, highlighting the need for ethical, high-quality, autistic-informed practice.
01Research in Context
What this study did
Ke et al. (2020) asked three groups in the Netherlands how they feel about ABA. The groups were autistic adults, parents, and professionals. They used surveys and small group talks to collect answers.
The team wanted to know who is happy with ABA and who is not. They also asked what worries each group most.
What they found
Parents and professionals said ABA helps kids talk and do things on their own. Autistic adults gave lower marks. Some said the therapy felt hurtful and left scars.
Overall, satisfaction is mixed. One size does not fit all.
How this fits with other research
Wilson et al. (2024) found the same cold feeling. Parents in their survey called ABA "robotic." Adding warm, relationship words raised parent approval. Both papers show parents want more heart in the program.
Lipinski et al. (2019) saw low satisfaction among autistic adults in regular talk therapy. The reason was therapist autism knowledge gaps. Yu’s adult data echo this point: when clinicians lack autism insight, adults walk away unhappy.
Byiers et al. (2025) mapped Dutch autism services and saw patchy guideline use. Yu’s mixed ratings fit that picture. Poor uptake of best practice may explain why some clients feel harmed.
Why it matters
If you run ABA sessions, hear all voices. Build in choices, breaks, and real-life fun. Check in with autistic clients often and adjust fast. Use plain language, written summaries, and shared goal setting. High-quality, kind ABA is still possible, but only when the client helps steer the ship.
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02At a glance
03Original abstract
Applied Behavior Analysis (ABA) is a widely recommended intervention for autistic children, but it has recently been criticized because of its potential negative effects on mental health. This study aims to map experiences with ABA and related techniques in the Netherlands by investigating different types of ABA interventions, experiences and satisfaction levels, and explores variations across techniques and stakeholders. An exploratory sequential mixed methods design was employed, beginning with qualitative focus groups (n = 22) followed by a quantitative online survey (n = 219). Participants included autistic adults, parents/legal representatives, and healthcare professionals. Focus groups revealed six main themes: diverse interpretations of ABA, variations in its application, positive experiences, concerns about overburdening and psychological impacts, criticisms of the healthcare system, and quality control issues. Survey results indicated that satisfaction with ABA interventions varied, with autistic adults being less satisfied than parents and healthcare professionals. Positive outcomes included improved communication and independence, while negative experiences involved trauma and concerns about ethical application. Better quality interventions were associated with higher satisfaction levels. The study reveals diverse experiences and interpretations of ABA. Participants raised significant concerns that merit attention alongside the noted benefits of ABA. Improving training and ensuring ethical practices are crucial to maximize ABA's potential to positively impact the lives of autistic individuals. Future efforts should focus on enhancing regulation, standardization, and incorporating autistic perspectives to optimize outcomes.
Psychiatry Investigation, 2020 · doi:10.30773/pi.2019.0229