Friday, December 18, 2015

Social Domain Theory and Behaviour Therapy in Autism

Neurodiversity advocates often criticize ABA by claiming that it is harmful to train an autistic child to act normal. However, curebies often seem to miss the fact that most neurodiversity advocates aren't against teaching an autistic child anything - rather, the concern is over the specific focus and goal of treatment.

I recently realized that a particular child development theory pretty much ideally sums up what behaviour neurodiversity advocates are fine with changing and what we believe should not be changed.

Social domain theory, which really doesn't get the attention it deserves, suggests that both children and adults implicitly feel that behaviour falls into several different domains, with different responses considered appropriate for each domain. In particular, the rules placed on individuals by authority figures are judged very differently based on what domain they fall into.

The first domain is the moral domain (ordering is arbitrary, by the way). These are behaviours seen as inherently morally wrong, and authority figures are not only allowed but generally required to forbid these behaviours. Even if a authority figure were to explicitly allow a behaviour in this domain, it would still be considered wrong. Most behaviours make it into the moral domain because they are seen as harmful to other people - such as physical violence, emotional abuse, or damaging property valued by another person. There are also some behaviours placed in the moral domain because they elicit strong feelings of disgust, although these are less universal (an example in the literature was having sex with a dead chicken with no intention of anyone eating that chicken).

The second domain is the prudential domain. These are behaviours seen as risky or unwise, because they are likely to cause harm to the person engaging in them. In this domain, whether authority figures should make rules about this domain is seen as depending on the competency of the person the rules are being placed on. Young children and older people reasoning abut young children generally approve of prudential domain rules, but as children get older, they expect and want to take responsibility for their own safety, and adolescents and adults often resent prudential domain rules. (A certain subset of adults refer to prudential domain laws as the 'nanny state', implying that these laws treat them like children.)

On the other end of the spectrum is the personal domain. These are behaviours seen as important for self-expression and identity. Not only are authority figures not expected to put rules on these behaviours, it is generally seen as morally wrong to forbid these behaviours. It is seen as harmful to inhibit personal domain behaviours, because these are important for the person's happiness - and therefore interfering with another person's personal domain falls under the moral domain. Common examples of personal domain behaviours include choosing what clothing to wear, what toys to play with, or similar choices. Also note that the moral domain overrides the personal domain - even if it is important to your identity to do a harmful activity (for example, sexually abusing a child), it is still wrong and should be forbidden.

Lastly, there's the social conventional domain. This is where behaviours that don't fall under any other domain are placed. Authority figures are seen as having free rein to allow or forbid any of these behaviours as they see fit, and generally end up setting rules consistent with a standard societal norm. For example, raising your hand before speaking in class falls into the social conventional domain. Generally, violating social-conventional rules is seen as mildly wrong, more rude than actually harmful, and only mild punishments are expected for violating these rules. And unique among any domain, whether a behaviour is allowed or not in this domain is entirely decided by whether there are rules (explicit or unwritten) against it.

Neurodiversity advocates pretty much universally approve of eliminating behaviour that falls into the moral domain. I have never seen anyone argue that an autistic child should be allowed to harm other people. Disgust-based moral domain behaviours are more of a point of contention (as they are in other areas - for example, homophobic people are thought to mostly forbid gay sex out of disgust-based moral reasoning) but even so, I have seen neurodiversity advocates argue against disgusting behaviour, and have even done so myself. (I was trying to convince an autistic adult online not to pee on sidewalks to save on his water bill.)

Similarly, in the prudential domain, neurodiversity advocates generally hold the same opinions as everyone else does. Young children should not be allowed to harm themselves - either by direct self-injury or by engaging in dangerous behaviour. Older children and adults will generally take over responsibility of their own safety and should decide for themselves what risks to place themselves under. However, there is sometimes a point of contention with disabled adults, especially more visibly disabled adults, because of a disagreement about how competent these individuals are to ensure their own safety. Specifically, neurodiversity advocates generally feel that competence is being underestimated for visibly disabled people, such as lower functioning autistic people.

There is also the question of what to do if the person understands the risks but can't ensure their safety. This is most often seen in the discussion of lack of independent living services for adult autistics, especially higher functioning autistics. I am lucky to have a family who is still caring for and supporting me, but others are homeless or living in terrible home situations because they can't care for themselves and no one else is giving them help. Meanwhile, since many autistics who need self-care help are still competent to judge risks and make good decisions, it's important that when we get the help we need, it's in a form we can control. That way, we can decide for ourselves what kind of help we need and how we want to receive it. Unfortunately, getting help, if help is available, usually means giving up control over your life to some inflexible agency.

The last two domains are where curebies and neurodiversity advocates generally disagree. The thing is that many typically autistic behaviours, such as intense interests, stimming, atypical play, etc are felt by autistic people to be important to our identity, and therefore fall under the personal domain. Meanwhile other people don't realize the importance of these behaviours (or are willfully blind to it, in some cases) and see them as being in the social-conventional domain.

Given the inverse relationship between the personal and moral domains, seeing certain behaviours as personal domain inherently leads to seeing attempts to stop those behaviour as moral domain violations. This is one of the big reasons why neurodiversity advocates are opposed to treatments like ABA, which often list reducing typically-autistic personal domain behaviours as explicit goals of therapy.

But there's another wrinkle, too. Many autistic behaviours that curebies see as social-conventional actually fall into the prudential domain, as self-protective behaviours used to protect the child from things that are harmful to them but not to others. Avoiding eye contact, resisting being touched, refusing certain foods, and some forms of stimming serve the role of reducing or preventing sensory discomfort. In my experience, most therapists working with autistic kids have no idea what sensory processing issues are - a pretty terrible oversight, given that these issues are near-universal in autistic people. (To give an idea how bad this is, it would be like someone dedicated to treating psychosis who had no idea what hallucinations were.) When even the experts are so ill-informed, it's understandable that many parents would be even more clueless about this issue. However, whatever the reason, prohibiting self-protective behaviours causes harm, which means such rules violate the moral domain.

So, really, our disagreement is not as great as curebies make out. We don't see a problem with telling a child not to hurt others or themselves. We also don't have an issue with teaching practical living and communication skills - both of which fall under prudential domain as self-protective skills. Where we disagree is in the idea of teaching autistic kids to stop doing self-protective and personal domain behaviours, simply because they go against social norms. Go ahead and teach your child to speak and write and dress themselves, that's no big deal. And if they don't mind, you can teach them some social conventional behaviours too, like saying please and thank you, or saying hello when someone else initiates conversation. But don't tell them how to play, don't stop them from stimming, and don't make them touch people, eat certain foods, or make eye contact if they strongly object to doing those things.