By Matt Harrington, BCBA · Behaviorist Book Club · Research-backed answers for behavior analysts
The medical model locates disability within the individual as a deficit, disorder, or pathology that needs to be treated, corrected, or remediated. The professional's role is to diagnose the problem and make the individual function as 'normally' as possible. The social model locates disability in the interaction between individual differences and societal barriers — disability is created when environments, policies, and attitudes fail to accommodate natural human variation. In practice, this difference shapes everything from how goals are written to how success is measured. The medical model measures success by how closely the individual approximates typical functioning. The social model measures success by the individual's quality of life, participation, self-determination, and access to valued activities and environments. Both models acknowledge that individuals have genuine differences in functioning; they differ in how they interpret and respond to those differences.
No. The social model does not oppose skill building — it reframes why and how skills are taught. Under the social model, skills are taught because they help the individual achieve their own goals and participate in activities they value, not because they move the individual closer to a 'normal' standard. The content of skill instruction may also change: instead of teaching a neurotypical social interaction style, a social model approach might teach multiple interaction strategies and let the individual choose which to use in different contexts. Some skill-building goals remain fully appropriate under the social model — communication skills, self-care skills, safety skills, and academic skills all enhance the individual's autonomy and participation. The key difference is that these goals are selected because they serve the individual's interests, not because they address professionally identified deficits.
Affirming goals follow the same measurement principles as any behavior analytic goal — they must specify observable behavior, conditions, and criteria — but the behavior targeted reflects the individual's values rather than external norms. For example, instead of 'Client will maintain eye contact for five seconds during conversation,' an affirming alternative might be 'Client will demonstrate a greeting response of their choice (verbal greeting, wave, nod, or other culturally appropriate acknowledgment) when encountering familiar people in at least three of five opportunities.' The goal is still specific, observable, and measurable, but it respects the individual's autonomy by offering choices and avoiding the assumption that eye contact is the only acceptable form of social engagement. The principle is to target functional outcomes that matter to the individual while allowing flexibility in how those outcomes are achieved. This approach often produces goals that are more socially valid and more likely to generalize because they align with the individual's natural behavioral repertoire.
This is one of the most common and most sensitive challenges in transitioning to social model practice. Families often enter ABA services with medical model expectations — they want their child to 'look normal,' stop stimming, make eye contact, and behave like typically developing peers. These expectations are understandable given the medical model framing that pervades disability discourse in healthcare and education. The practitioner's role is to engage in ongoing, respectful dialogue that helps families understand alternative perspectives without dismissing their concerns. This might include sharing information about the functions that stimming and other autistic behaviors serve, discussing research on the psychological costs of masking for autistic individuals, exploring what specific outcomes the family is hoping to achieve (often social acceptance and independence) and identifying affirming pathways to those outcomes, and connecting families with autistic adults who can share their perspectives on ABA goals.
Neurodiversity-affirming ABA in daily practice involves several observable shifts. Sessions include high levels of choice-making for the client, with the individual selecting activities, reinforcers, and break times. Stimming and other self-regulatory behaviors are accommodated rather than targeted for reduction unless they cause physical harm. Goals focus on building functional communication, self-advocacy, self-determination, and participation skills rather than approximating neurotypical behavior patterns. The therapeutic relationship is characterized by mutual respect — the clinician follows the client's lead when appropriate, responds to assent withdrawal by pausing and modifying activities, and treats the client's preferences as valuable information rather than obstacles to treatment. Environmental modifications (sensory accommodations, visual supports, predictable routines) are implemented proactively rather than relying solely on the individual to adapt to challenging environments. Data collection captures quality-of-life indicators and participation measures alongside traditional behavioral data.
Insurance authorization criteria have historically been structured around medical model concepts — medical necessity, deficits relative to developmental norms, and remediation of diagnosed conditions. However, many social model goals can be framed in terms that meet these criteria while still reflecting affirming practice. A goal to develop functional communication skills, for example, addresses a medical necessity (communication deficit) while building the individual's capacity for self-determination and self-advocacy. Practitioners may need to articulate social model goals in language that resonates with insurance review criteria while maintaining the affirming intent behind the goals. This is not deception — it is translating between frameworks to ensure that clients receive the services they need. Over time, advocacy for changes in insurance authorization criteria to recognize quality-of-life and participation outcomes will help align funding structures with social model practice.
The social model and assent-based care are deeply complementary. Both frameworks center the individual's perspective and autonomy in the treatment process. The social model provides the conceptual foundation — the belief that the individual's differences are part of natural human variation and that their preferences and perspectives deserve respect. Assent-based care provides the clinical mechanism — the ongoing monitoring of and responsiveness to the individual's expressed willingness to participate in treatment activities. Together, these frameworks create a practice model where treatment goals reflect the individual's values (social model), treatment procedures are implemented in ways that respect the individual's moment-to-moment preferences (assent-based care), and treatment success is measured by the individual's quality of life and self-determination rather than their approximation of externally defined norms.
Autistic professionals bring essential lived experience that non-autistic practitioners cannot replicate. They can identify when goals, procedures, or assessment practices are experienced as harmful or disrespectful by autistic individuals — insights that may not be apparent to non-autistic clinicians who have never experienced ABA from the receiving end. Their involvement in training, consultation, research, and policy development ensures that the autistic perspective is directly represented rather than interpreted through a non-autistic lens. The fact that this course is developed by an autistic-led peer group exemplifies this contribution. Autistic professionals can articulate what affirming practice looks and feels like from the inside, provide feedback on whether new approaches genuinely serve autistic interests or simply repackage old assumptions in new language, and model the kind of neurodiversity-affirming professional relationships that the social model envisions.
No — in fact, the social model is highly compatible with behavior analysis when the field's foundational principles are applied consistently. Behavior analysis holds that behavior is a function of the environment. The social model holds that disability is a function of the interaction between individual differences and environmental barriers. Both frameworks emphasize environmental analysis and environmental modification as primary change strategies. The tension between ABA and the social model has arisen not from incompatible principles but from inconsistent application of those principles. When behavior analysts focus exclusively on changing the individual's behavior without adequately analyzing and modifying the environmental conditions that create barriers, they are arguably departing from the environmental determinism that defines their discipline. The social model reminds behavior analysts to apply their own principles more completely — analyzing and modifying the full range of environmental variables, including social attitudes, institutional practices, and physical environments, that influence behavior.
Begin with self-education: read first-person accounts from autistic adults, study the social model literature, and engage with neurodiversity-affirming resources from behavior analytic and disability studies perspectives. Then apply what you learn to a concrete review of your current practice — examine your existing treatment plans, goals, and assessment procedures for medical model assumptions that may not be serving your clients' best interests. Make one change at a time. Revise one set of goals to be more affirming. Add an environmental modification target to one treatment plan. Conduct a social validity assessment that specifically asks whether treatment goals reflect client and family values. Practice writing goals that offer choices and build on strengths rather than targeting deficits. Each small change builds competence and confidence with the social model approach, and the cumulative effect over time is a more affirming, more ethical, and more effective practice.
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Transitioning from the Medical Model to the Social Model of Disability: Practicing Affirming Goal Writing — Mary Rose Winters · 2 BACB Ethics CEUs · $30
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.