Editor's note: This article references sexual assault, ABA therapy, self-harm, and restraint training for use on children with disabilities. Reader discretion advised.
A Career ShiftI was living life as a non-autistic professional-- or so I thought-- when I found myself training to be an ABA technician. To fulfill the required supervised hours for my clinical psychology license, I accepted a position working with adults with pervasive mental illness and other personality disorders. My specialty at the time was trauma. But my new employer was dealing with an influx of referrals for something called Applied Behavioral Analysis (ABA) and asked me to first to help reduce that backlog before focusing on my specialty. So, I was pushed into ABA, the most aggressively-advertised therapy for autism. I was told it was the only hope for autistic kids to live a normal life-- the "gold standard" of care. ABA is an abbreviation for applied behavior analysis. To become a registered behavior technician (RBT), I had to take an online course that took approximately 30 hours. That was it. For the employer, I had to attend a few trainings on the ground: HIPAA, patient rights, and some information on benefits packages and human resources. There was only one training on the whole schedule lasting more than two hours, and it was the only training specific to my position as an RBT. This training was called "Therapeutic Options."
Therapeutic OptionsTherapeutic Options. It looked innocuous enough sitting there on the last day of the orientation schedule. I had no idea what it entailed, but I was not emotionally prepared for the reality of this training. It was essentially an 8-hour course in defensive martial arts. I. Was. Terrified. I don't like to be touched or to touch others unless it is someone with whom I'm extremely comfortable. Touch aversion makes doctor appointments, hair cuts, and crowded spaces very difficult. But, this was a training in how to deal with aggressive clients-- "ethical" defense maneuvers and restraints. What that translated to was hours and hours of allowing a large man or one of the other trainees to grab me from behind, for me to grab them from behind, for people to run at me, lunge at me, swing at me, and for me to do those things to others. My fear was that I would be so upset by all of this touching and grabbing that I would not be able to contain myself, and that I would run away, or scream, or worse... that I would lose control and break away or elbow or throw my head backwards much like someone might do when they're being tickled to the point of torture. At the time I believed this to be a manifestation of complex PTSD, a diagnosis I had hard-earned. My logical mind knew that being touched like that was not an actual attack; however, the more I had to tolerate what was distressing me, the more my anxiety built to a point I doubt most people have ever come close to experiencing.
What Non-Autistics Need to UnderstandI'm a word person. I have all the words, but there will never be enough words to describe how intense my anxiety is when intolerable sensory input continues beyond my threshold. Sensory input that involves other people comes with extra layers of accountability. Messing up and tipping my hand would've meant losing my tenuous grip on having a professional life. I've been through years of dialectical behavioral therapy and decades of being a traumatized autistic person. My ability to suffer in silence is monastic. I have taught myself to shoulder such profound suffering and appear centered that-- not once, but twice-- I've shown up to work with sepsis and multiple organ failure, yellow as a lemon. I was wearing heels, my hair was fixed, my clothes were starched and ironed, I was on time, and I smiled at everyone there as I walked in. I made small talk and eye contact. I am a #meToo survivor. I was brutalized to the point of needing surgical repair; however, sexual assault did not leave me with the intense trauma imprint that this Therapeutic Options training did. At least during the rape, I did not have to maintain professionalism and force eye contact. At least I did not feel the full weight of my future collapsing with the potential loss of my my dream job before it even got started. At least it didn't last 8 hours. At least I had the option to fight back. At least after it was over, I did not have to think I was the only one in the world who had those feelings. Every hard and soft part of another's body pressing into mine, the temperature shifts on every micrometer of my skin, the individual hairs on my arms bending and responding to the static charge and the myriad textures of everyone's clothes, the soaps and foods and perfumes and hair products, the smells of sinus infections, bad teeth, and dehydration, the height and weight differences, the textures of scratchy sweaters and soft cotton, masculine arm hair and beards, the crunch of styled hair, the give of another's soft stomach under my hard elbow as I imitated assaulting them-- they were a hundred million individual events my brain could not weave together. But, that is the burden of being autistic and not knowing it. I literally feared a heart attack or seizure. It was as intense and unbearable as electrocution. And I had to appear fine. I can feel, in full dimension, every contour of the terrain of someone's anatomy against mine like individual pixels on a photo. To take in that much information, to manage all the social nuances and see every microexpression, every pore on someone's skin, every light spot on every tooth and every hair in every nose-- to make sense of it all immediately and then behave "normally" is like navigating a space shuttle through a labyrinth with the thrusters at full blast. I was the one accidental method actor in the room. But, that was the sensory management. The psychological hell was worse. The social hell of being autistic has plagued me my whole life, and I've thought I was insane and broken. I don't anymore. It was not me with the perceptive problems. I went through this training with the rapidly-building panic about the social and professional consequences of letting the world know how abnormally I was reacting to what others were casually making out to be like a joke. The trainees giggled as they lunged at each other, imitating aggressive sounds and "getting in character." Some flirted. There were innuendos and self-effacing jokes about getting so intimately entangled with each other. I could not find any humor in imagining restraining someone overcome with emotion or in deflecting a physical attack from a child with a developmental disability. They weren't imagining the children, though. They weren't letting the weight of the big picture press them into the earth and crush them. They were having fun like this was a choreography class for a flash mob. They were in the moment, having a laugh with their trusted colleagues (even though they'd just met), and I didn't feel that bond with them enough to have their bodies braided into mine. In their minds, they were different from those children. I wasn't feeling that many degrees of separation. I didn't have a choice. I was-- as in just about every vignette and venue of my life-- on the wrong side of the situation. I was the person whom these people would be restraining if that training had lasted any longer or if I allowed one more large man to come up behind me and grab me.
How to Survive as an Autistic in Sensory OverloadI broke a tooth-- a molar-- in the middle of that training from grinding my teeth so hard. Somehow the pain of it, the taste of blood in my mouth, and the distraction calmed me down. Self-injurious behavior was one reason to use restraints. If I had been a child there, I would have been restrained. No one would have considered their role in getting me to that point. No one would have thought about how abnormal and toxic and decidedly not-funny it is to have a class practicing what they told us at the beginning had killed children before. Killed. Ended the lives of children. Broken spines and bones. Crushed windpipes. I had a pain much less penetrating on which I could focus. To be a certified instructor in "Therapeutic Options," one needs four days of training. That's it. Four days to learn how to teach people maneuvers that kill and traumatize autistic kids. To restrain autistic children, you need 8 hours of training in a group of silly adults who are not going to remember a single maneuver after the course. It typically takes someone years to earn a blackbelt in defensive martial arts. There is great care to reinforce at every step how and when using force is acceptable, and it is as a last resort. No one in martial arts training would advocate that it's acceptable to defend against someone who is being held hostage. But this wasn't discussed. Not once did anyone mention that maybe children shouldn't be subjected to compliance training. It was a joke, and people like me were the punchline. I didn't stay in the job long. It was clear I wasn't a fit. I would have never gelled with the position, wouldn't have ever been compliant enough to accept the strategies. I was let go shortly thereafter when the BCBA was fired, and I have never worked since. That day ruined me. It broke my soul.
The Take-Away:When reading something written by an autistic person, non-autistic people often are left wondering what is the point. We tend to state the facts and hope that your personal life experiences will provide you context to draw your own conclusions. For example, if you're a parent of an autistic child, a teacher, an ABA practitioner, or an employer, I would hope that you could understand how an autistic person's subjective experience of a situation can be so dramatically different from your own. If you're an ABA practitioner, you would not have picked me out from the crowd that day as experiencing problem behaviors. You wouldn't have seen my self-harm. I would have been indistinguishable from my peers. You would've considered my behavior training a success. I was compliant, I smiled, I made eye contact. And four years later, I still am having panic attacks just trying to write the story down. You would have had no idea the power dynamics at play and how ominous and imposing the advantage you wielded over me was as you touched my body in ways that were deemed socially-appropriate according to the status quo. You wouldn't have known how important it was for me to be able to escape. You wouldn't have known that you were doing something to me that would take center stage in my trauma flashbacks-- even over a rape. I fooled you into thinking I was one of you, but that wasn't a sustainable victory, and nobody won. I would like you think about how much a victory it really is when a woman walks into work with her hair curled and her make-up perfect while in kidney and liver failure-- but still making that normative eye contact and still flashing a smile. I've done that twice. The world taught me that magic trick, with or without ABA. My observable behaviors aren't a reflection of my experience. My superpower is persisting. This is why heart disease from stress and suicide are top causes of death for autistics and why we have an average life span of 36.5 years of age. I want you to apply the context of your experiences against the glimpse you've had into mine.
Further Reading:Earlier this month, several national civil rights organizations, including COPAA, the Autistic Self Advocacy Network, and CommunicationFIRST, joined four students in a federal lawsuit against Fairfax County Public Schools for abuses relating to the restraint and seclusion of children with disabilities. In this press release, it's noted that one student was restrained 745 times. From CommunicationFIRST's website:
CommunicationFIRST is the only nonprofit organization dedicated to protecting and advancing the civil rights of the more than 5 million people of all ages in the United States who, due to disability or other condition, are unable to rely on speech alone to communicate.To read more about restraint and seclusion, follow International Coalition Against Restraint and Seclusion (ICARS) on Facebook and Twitter. The post Becoming an ABA Registered Behavior Technician Before Knowing I Was Autistic: Part 1 – Restraint Training appeared first on NeuroClastic.