From Medical Model to Social Model: Writing Disability-Affirming Goals in ABA

Overview & Clinical Significance

Goal writing in ABA has long been shaped by the medical model of disability, which locates the problem in the individual—in the behaviors, deficits, or traits that distinguish them from a normative standard. The social model of disability, by contrast, locates barriers not in the individual but in social structures, environments, and institutional practices that fail to accommodate human diversity. Mary Rose Winters' course, delivered through Mindful Behavior's autistic-led Peer Group, invites practitioners to interrogate their goal-writing practices against this distinction and to develop the skills needed to write goals that align with the social model's emphasis on inclusion, empowerment, and individual strengths.

Goals grounded in the medical model frequently target behavior reduction or compliance with normative social standards that the client has not been asked whether they value. Goals grounded in the social model target improvements in the client's participation in environments and activities they find meaningful, access to community opportunities they choose, and development of self-advocacy skills that increase their agency over their own lives.

Amorim et al. (2025) demonstrated that theory of mind profiles vary substantially across neurodevelopmental conditions, reinforcing that the assumption of a single normative developmental trajectory—the foundation of medical model goal writing—is empirically unsupported. Goals written against a single normative standard systematically disadvantage clients whose profiles diverge from that standard in ways that are neurological, not merely behavioral.

For BCBAs operating under BACB Ethics Code (2022) Code 2.01, this course addresses the requirement that treatment goals be socially valid and align with client values and priorities. Goals that target normative compliance without the client's genuine endorsement may satisfy payer authorization criteria while failing the client's actual preferences.

Background & Context

The medical model dominated disability services throughout most of the twentieth century, establishing a framework in which disability was defined as a pathology requiring treatment, the goal of intervention was approximation of non-disabled norms, and the professional was the authoritative agent who determined what outcomes were appropriate.

The social model emerged from the disability rights movement of the 1970s and 1980s, primarily articulated by disabled people themselves who challenged the assumption that their lives needed to be normalized. The social model identifies two categories of impact: impairment (differences in body or mind) and disability (the barriers created by environments and institutions that do not accommodate those differences). Disability, in this framework, is not intrinsic to the individual—it is produced by the interaction between the individual and an inaccessible world.

Chang (2026) examined how evidence framing shapes professional conclusions, arguing that research comparing ABA to other approaches embeds assumptions about what counts as a good outcome. That critique applies directly here: if the outcome measure is approximation of non-disabled behavior, the social model's preferred outcomes—quality of life, community participation, self-determination—will systematically underperform in any comparison.

Al Aqel et al. (2026) found that parental awareness and attitudes toward autism shape family engagement with services. Families who have internalized medical model assumptions about their child's disability may initially resist social model goal writing, viewing it as lowering expectations.

Practitioners must develop skills for explaining the framework and engaging families collaboratively while honoring their knowledge of their child.

Clinical Implications

Writing goals from the social model requires restructuring the practitioner's assessment process. Rather than beginning with a deficit inventory—what skills is this client missing relative to age norms?—social model assessment begins with a participation inventory: what activities and environments does this client want to access, and what barriers currently prevent that access?

Adams (2026) found that structured interventions for autistic individuals produce better outcomes when they target problems the individual identifies as significant, rather than problems identified by external criteria. The social model goal-writing process operationalizes that finding at the treatment planning level: the client's identification of meaningful targets is the primary input.

Social model goals typically look different from medical model goals at the linguistic level. Instead of "Client will reduce hand-flapping to zero occurrence during group instruction," a social model goal might read: "Client will identify at least two strategies for managing sensory input in group settings and report using at least one per week." Instead of "Client will make eye contact with the speaker for 80% of conversational turns," a social model goal might read: "Client will demonstrate at least three communication behaviors that indicate engagement during conversations with preferred partners."

Tong et al. (2026) found that mealtime behavior problems in autistic children are associated with a complex array of sensory, behavioral, and social variables. A medical model approach targets the behavior topography—refusal, selectivity—while a social model approach asks: what would make this mealtime experience more accessible for this individual and allow fuller participation with family members?

Ethical Considerations

BACB Ethics Code (2022) Code 2.01 requires that behavior analysts pursue effective treatment based on the best available scientific evidence and tailored to the individual's needs, preferences, and values. The social model of disability is not anti-science—it is a framework that expands what counts as a clinically relevant outcome. Ignoring client preferences and values in goal selection is not consistent with Code 2.01.

Code 2.14, which requires ongoing assent from clients, aligns directly with social model practice. A goal that the client has not endorsed—either explicitly or through behavioral indicators of engagement—is operating without assent. Goals that target the elimination of behaviors the client values, or that require approximating norms the client does not accept as relevant, are structurally likely to produce assent withdrawal.

Martín-Díaz et al. (2026) documented that motor difficulties in autistic youth affect autonomy and participation in daily activities. Social model goal writing for motor targets would prioritize the specific activities the client wants to participate in—playground access, sports participation, independent navigation—rather than normalized motor performance metrics disconnected from the client's life.

Murphy et al. (2025) found that autistic adults' retrospective accounts of their experiences may be shaped by relational processing differences. This finding underscores the importance of real-time preference assessment rather than reliance on retrospective self-report in establishing what goals a client values.

The social model's emphasis on collaboration and ongoing consent is supported by this neurocognitive finding.

Assessment & Decision-Making

Transitioning from medical model to social model goal writing requires a structured assessment process. The course identifies several assessment tools: participation inventories, ecological interviews focused on desired activities rather than deficits, preference assessments that extend beyond tangible reinforcers to identify valued activities and environments, and structured conversations with self-advocates about what a good life looks like to them.

Decision-making about goal selection should be explicitly collaborative. The practitioner brings knowledge of behavioral principles and evidence-based intervention strategies; the client and family bring knowledge of what matters in their actual life. Neither knowledge base is sufficient alone.

Amorim et al. (2025) documented variation in theory of mind across neurodevelopmental profiles that has direct implications for the format of preference and goal-setting assessment. Clients with limited theory of mind may have difficulty generating preferences in the abstract; assessment that embeds preference elicitation in concrete activity choices or environmental configurations is more likely to produce valid data.

Persichetti et al. (2025) examined how autistic individuals navigate using map-based versus landmark-based strategies, finding that profile-specific differences require profile-specific support approaches. That individualized lens—not assuming a generic strategy will work—is the social model's methodological contribution to assessment design.

What This Means for Your Practice

The most actionable step from this course is to review the active goals for at least two current clients and evaluate each against the following question: does this goal reflect what the client values, or what a normative standard specifies? For goals that appear primarily driven by normative comparison, identify whether there is a social model equivalent—a goal that preserves the developmental priority while targeting participation and autonomy rather than normative approximation.

Writing in social model language does not require sacrificing measurability. Behavioral targets can be operationalized as participation behaviors, communication repertoires, and self-advocacy skills that are just as precisely defined as traditional behavioral goals. The change is not in the measurement methodology but in the underlying values that determine what is worth measuring.

Al Aqel et al. (2026) found that how practitioners communicate with families shapes family perceptions and engagement. Introducing the social model to families requires explaining the framework clearly, connecting it to outcomes the family cares about, and being explicit that the shift in language reflects a shift in values—not a reduction in clinical rigor.

Thomas et al. (2026) reviewed how brief, specific, contingent feedback accelerates skill acquisition across domains. For practitioners learning to write social model goals, the same training format applies: specific feedback on the goal language itself—pointing out exactly which phrase reflects medical model framing and offering a concrete social model alternative—will produce faster skill development than abstract conceptual discussion alone.